Sir,
In this video, we attempted to review the nuances of endarterectomy procedure in a step-by-step manner for young neurosurgeons. The patient is positioned supine with the head slightly extended and rotated contra-laterally. An oblique incision in front of the sternocleidomastoid muscle is made. A meticulous hemostasis is required in this procedure so all the layers are dissected with judicious use of bipolar coagulation. After opening the carotid sheath, an intra-operative angiography is performed to make sure of enough exposure of the internal carotid artery and also to locate the atherosclerotic plaque. The common and internal carotid arteries are incised along the plaque. We insert an arterial shunt in all cases and monitor cerebral oxygenation level throughout the procedure. By using a sharp dissector, the plaque is dissected apart from the arterial wall little by little. After totally removing the plaque, the shunt is removed and the arterial wall is sutured by running technique. The sequences of removing the arterial clamps are demonstrated in the video. Patient selection, advanced monitoring, and performing the procedure in ordered steps are key points in achieving good results.
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