OR / Prep · Vascular Surgery · open
You’re scrubbing into
Carotid endarterectomy
Why are we operating?
Coring the stroke-throwing plaque out of the carotid bifurcation, done soon after the warning event, with three cranial nerves watching the field.
Indication: Symptomatic carotid stenosis (TIA or minor stroke with 50-99 percent stenosis), ideally within two weeks of the event.
The operation in 4 steps
01Exposure
02Clamping, and the shunt question
03The endarterectomy
04Patch closure and restoration of flow
Danger zones
Hypoglossal nerve
High plaques force the dissection up to and past it, and it hides behind a veil of small veins that bleed at the worst moment.
Watch it done
Carotid endarterectomy: technical pearls and pitfalls (preview)
Exposure, clamping, the arteriotomy and the plaque, with the nerves that get injured.
Source: Neurosurgical Atlas, Aaron Cohen-Gadol MD · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.