“High” ICA LesionsTechnical Adjuncts - Exposure

“High” ICA LesionsTechnical Adjuncts - Exposure

• Divide the ansa-hypoglossal nerve

• Release and reflect the hypoglossal nerve anteriorly

• Divide the digastric muscle

• Reflect vagus anteriorly superior to nodose ganglion

“High” ICA LesionsTechnical Adjuncts -

Long Tongue of Plaque

• Do not do a blind distal endarterectomy• Make decision to leave tongue of plaque before

taking endarterectomy to end of arteriotomy• Either tack down end point ~ 1/2 cm from end

of the arteriotomy and patch, or reconstruct with a bypass beveled over tongue

Summary-Technical Adjuncts

• Cardiac - Block carotid sinus, give atropine

• CEA+CAB - CEA with vein harvest, drain

• Contralateral occlusion - Shunt

• Hostile Neck - friable artery, vein patch or bypass

• High ICA Lesion - Exposure (hypoglossal, diagastic, vagus), reconstruction (patch, bypass)