Carotid endarterectomy from the neurosurgeon's perspective

Area of Science:

• Neurosurgery
• Vascular Surgery
• Cerebrovascular Surgery

Background:

• Carotid endarterectomy (CEA) is a surgical procedure to remove plaque from carotid arteries.
• Performed by surgeons, vascular surgeons, and neurosurgeons.
• This article focuses on the neurosurgical approach to CEA.

Purpose of the Study:

• To familiarize readers with the neurosurgical principles and techniques of carotid endarterectomy.
• To highlight the advantages of a microsurgical approach in CEA.

Main Methods:

• Utilizes general or locoregional anesthesia, with general anesthesia predominating in neurosurgical departments.
• Employs a microscope or exoscope for enhanced visualization, magnification, and illumination.
• Features a gentle running suture technique to minimize vessel wall trauma and reduce restenosis risk.
• Selective use of shunts, guided by somatosensory evoked potentials and EEG monitoring.
• Rarely uses eversion endarterectomy for specific anatomical challenges like carotid artery kinking.

Main Results:

• Microscopic visualization allows for precise dis-obliteration of atherosclerotic plaque.
• Microsurgical techniques and primary suture closure significantly reduce the risk of residual stenosis or restenosis.
• Somatosensory evoked potentials combined with EEG effectively guide the selective use of shunts.

Conclusions:

• Neurosurgical CEA is characterized by the use of microscopes/exoscopes, microsurgical techniques, and selective shunting.
• Microendarterectomy with primary suture remains the dominant neurosurgical technique for carotid artery stenosis.
• This approach ensures precise plaque removal and minimizes complications.