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Extra-Intimal Carotid Endarterectomy: Two-Dimensional Microsurgical Approach
Sarosh Irfan Madhani1, Soliman Oushy1, Luis Savastano1
1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurgery
|March 6, 2022
Summary
This new extra-intimal carotid endarterectomy technique allows for the removal of intact atherosclerotic plaques. This method preserves specimens for research and avoids plaque disruption during surgery for carotid artery stenosis.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Surgical Innovation
Background:
- Carotid endarterectomy is standard for symptomatic carotid artery stenosis.
- Current surgical methods disrupt plaque, hindering research specimen collection.
- A novel technique is presented to address these limitations.
Observation:
- A 70-year-old male with aphasia presented with severe calcified left internal carotid artery stenosis and multiple strokes.
- An extra-intimal carotid endarterectomy was performed, creating a dissection plane between the media and intima.
- The intact atheromatous plaque was removed, and the arteriotomy was repaired.
Findings:
- The extra-intimal technique successfully removed an intact plaque in a patient with severe calcified stenosis.
- This approach resulted in no complications, with the patient discharged the next day and remaining asymptomatic at 1-year follow-up.
- The technique has been used in 55 consecutive patients without complications, proving effective even in highly calcified lesions.
Implications:
- This technique provides intact atherosclerotic specimens for high-quality research.
- It minimizes manipulation of the arterial wall and plaque.
- The method is fast, reproducible, effective, and safe for treating carotid artery stenosis.
