Pitfalls During Carotid Endarterectomy

Abstract

Carotid endarterectomy has been used in the management of patients with arteriosclerotic cerebrovascular occlusive disease since it was described by Carrea et al. in 1956 [5]. DeBakey [7] made considerable efforts toward making this procedure safe and acceptable in the management of patients with cerebral ischemic symptoms. Most use the procedure for patients presenting with unilateral cerebral ischemic symptoms which result from arteriosclerotic lesions in the ipsilateral carotid artery [1–4, 12, 18, 23, 24]. These patients, in general, should have presented with transient ischemic attacks, reversible ischemic neurological deficits, or mild cerebral infarctions which have resolved, leaving only a minor or no residual deficit [3, 6, 12, 13]. The carotid lesions considered suitable for surgical excision are stenotic lesions which encompass 80% or more of the cross-sectional diameter of the artery as seen on biplane angiography, and/or lesions which are ulcerated with or without significant associated stenotic lesions [1, 10, 12, 13, 18, 19, 21]. The types of ulcers found most likely to result in embolie phenomena are the C-type lesions described by Moore et al. [15]; these are large and irregular ulcerated lesions.