Preface
Preface
Contents
Basics
1 What Is CEA
2 Measurement of Carotid Stenosis and Surgical Indications
2.1 Carotid Stenosis Measurement
2.2 Surgical Indications and Factor-Related Complications
2.2.1 Surgical Indications of CEA
2.2.2 High Risk Factors of CEA
2.2.3 Microsurgical Anatomy of CEA
3 Simplified Criterion of CEA Indication
4 MRI and Surgical Timing
5 Ultrasound Doppler and Angiography Workup
6 Bilateral Carotid Artery Stenosis
7 Intraoperative Monitoring
CEA Surgical Technique Essentials
1 Preoperative Management
2 Position and Intraoperative Monitoring
3 Intraoperative and Postoperative Blood Pressure Management
4 Surgical Exposure Technique
4.1 Variable Location of Carotid Bifurcation
4.2 Adequate Dissection and Gentle Retraction
4.3 Placement and Release of Clamping Forceps
4.3.1 The “External-Common-Internal” (ECI) Principle
4.3.2 Arterial Identification
4.3.3 Clamping Modality
4.3.4 Blocking Position
5 Arteriotomy and Plaque Dissection
6 Arteriotomy Closure
7 Closure
8 Postoperative Management
CEA Typical Cases
1 Incision, Exposure, and Surgical Indications
2 Surgical Timing
3 Carotid Stenosis with Ipsilateral Intracranial Aneurysm
4 Insufficient Compensation
5 Choice of the Side
6 Combined Heart Disease
7 High Carotid Plaque
8 Rotation of the Carotid Artery
Frequent Asked Questions of CEA
1 Anatomical Variations of CB Location and Morphology
1.1 High CB or High Plaque
1.1.1 Absolute High CB
1.1.2 Relatively High CB
1.2 Low CB
1.3 Carotid Tortuosity
1.4 Carotid Dissection
2 “Hai” Carotid Sheath (HCS)
2.1 Introduction of “Hai” Carotid Sheath (HCS)
2.2 “Hai” Carotid Sheath Dissection
3 Carotid Rotation
4 Characteristics of Carotid Plaque
4.1 Discrepancy between Operative Findings and Angiography of Carotid Plaque Length
4.2 Carotid Plaque Calcification
4.3 Carotid Occlusion
5 Management Strategy during Operative Exposure
5.1 Exposure of SCM, IJV, and Unexpected Bleeding
5.2 Manipulation of the Common Facial Vein (CFV), Transverse Cervical Nerve (TCN), and the Greater Auricular Nerve (GAN)
6 Carotid Opening and Repair
6.1 Location of Carotid Opening
6.2 Carotid Wall Rupture
6.2.1 ECA or its Branches
6.2.2 CCA
6.2.3 ICA
6.3 Bleeding from Vaso Vasorum of Carotid Arteries
6.4 Carotid Occlusion
6.5 Intraoperative Detriment of Tunica Media: Crack or Avulsion
6.6 Postoperative Cervical Hematoma
6.6.1 Arterial Origin
6.6.2 Venous Origin
7 Issues about the Clamping
7.1 Precaution of Ecclasis of Atheromatous Plaque
7.2 Inadequate Clamping and Arterial Leakage
8 Hyper-Perfusion Syndrome (HPS)
8.1 Mild
8.2 Moderate
8.3 Severe (Hemorrhage)
9 Carotid Restenosis
10 Cardiac Arrest
11 Postoperative Hypotension
12 External Carotid Endarterectomy
Summarized Process of CEA
1 Pre-op Management
2 Surgical Team Preview
3 Surgical Steps
3.1 Preparation Period
3.2 Intraoperative Procedure
3.3 Postoperative Prescription
3.4 Postoperative Check
3.5 Expected Complications
3.6 Follow-up
Appendix: Carotid Endarterectomy Specialized Instrument Set
Special Instruments of CEA