CAROTID MICROENDARTERECTOMY

THE ILLUMINATION AND magnification provided by the operating microscop e allow for the accurate and complete removal of atherosclerotic plaqu e from the carotid arterial wall, for precise arterial repair at the d istal end of the internal carotid endarterectomy, and for a fine, nons tenosing arteriotomy closure. A high dissection of the internal caroti d artery, allowing arterial exposure above the plaque, is particularly helpful in the performance of carotid microendarterectomy. The techni que of carotid microendarterectomy has been used in a consecutive seri es of 60 patients with symptomatic carotid stenosis, all but 5 of whom had carotid stenoses of 70% or more. In this series, there were no de aths and only one postoperative stroke, due to occlusion at the operat ive site. Emergency thrombectomy and angioplasty restored blood flow, and the patient recovered. In this and all other patients, carotid pat ency after surgery has been confirmed (angiography in 6 and Doppler ex amination in 54). Although postoperative stroke risk is dependent upon many factors, we feel that the refinements afforded by the operating microscope help reduce the risks associated with surgical technique to a minimum.