Carotid Endarterectomy for High Plaque and Interposition Grafting
Recommended Citation
Hans SS. Carotid Endarterectomy for High Plaque and Interposition Grafting. Extracranial Carotid and Vertebral Artery Disease 2025; :141-147.
Document Type
Book
Publication Date
3-12-2025
Publication Title
Extracranial Carotid and Vertebral Artery Disease
Abstract
High plaque in a patient undergoing carotid endarterectomy is defined as extending to the level of second cervical vertebral body. In majority of cases, high plaque can be diagnosed by CT angiography of the neck. Distal exposure of the internal carotid artery is facilitated by division of sternocleidomastoid branch of occipital or occipital artery itself and division of post belly of digastric and stylohyoid muscle. Mandibular subluxation to obtain distal exposure of ICA may be necessary. There is higher incidence of cranial nerve palsy in patients undergoing CEA for high plaque. Carotid interposition grafting (CIG) is an uncommon operation as compared to carotid endarterectomy (CEA). The exposure is similar to CEA for high plaque. In some patients, distal control of the ICA may necessitate balloon occlusion. Interposition graft material can be a tapered PTFE graft, great saphenous vein graft, or superficial femoral artery conduit in patients with head and neck malignancy invading the carotid artery. Distal anastomosis of the graft to the divided ICA is performed first followed by proximal anastomosis of the divided CCA to the graft. The external carotid artery is usually ligated.
First Page
141
Last Page
147
