Technical Aspects of Carotid Artery Surgery

Abstract

This article reviews the step-by-step description of the author's operative technique in performing a carotid endarterectomy. Technical precision remains the most important factor in reducing the risk of perioperative stroke. An in dwelling shunt is used selectively based upon the internal carotid back pressure or intraoperative monitoring of the electroencephalogram. Intraoperative use of a sterile Doppler probe permits comfirmation of flow abnormalities detected in noninvasive examinations preoperatively, documents flow in an indwelling shunt, and assures patency of the carotid artery and its branches after endar terectomy. Postoperatively noninvasive diagnostic techniques permit assessment of carotid integrity in patients suffering neurologic deficits, and serial studies provide objective evidence of the incidence of recurrent stenosis or disease pro gression. Using these diagnostic and therapeutic principles the author reviews the results of his series of patients in a residency training program.