Carotid Endarterectomy for High Plaque

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.