Which layer commonly needs repair with a
carotid endarterectomy?
Carotid endarterectomy (CEA) is a surgical revascularization technique employed to diminish long-term hazard of recurrent ipsilateral transient ischemic attacks (TIAs) or ischemic stroke in patients exhibiting:
A. Symptomatic, high-grade (>70%) internal carotid artery (ICA) stenosis.
B. Stenosis is established by:
i. Carotid duplex ultrasonography
ii. Computed tomography angiography (CTA)
iii. Magnetic resonance angiography (MRA)
iv. Digital subtraction angiography (DSA)
Surgical Technique
1. Under general anesthesia, carotid bifurcation is exposed via longitudinal cervical incision.
2. Common (CCA), external (ECA), and internal carotid arteries (ICA) are meticulously dissected.
3. Vessel loops/microclips are applied proximally and distally to induce temporary occlusion.
4. Systemic heparinization maintains activated clotting time >250 seconds intraoperatively.
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