Sunday, January 13, 2013

Microsurgical inter-intimal dissection in carotid endarterectomy

Available online 12 January 2013
Publication year: 2013
Source:World Neurosurgery

Objective Safe and complete surgical excision of carotid plaque in carotid endarterectomy (CEA) is essential for preventing postoperative embolic stroke and restenosis. We considered the dissection plane for the plaque according to pathological findings of carotid atherosclerosis. Objective: To report our experiences with inner-intimal dissection in CEA. Methods To obtain complete resection of the plaque with a smooth distal edge and bloodless surface by minimal exposure of the media, the thickened intima was sliced under high-magnification microscopy. The excised specimens were examined pathologically. Results Sixty-three CEAs were performed for 61 patients with carotid stenosis. Complete resection without tacking suture was obtained in all procedures. No mortality was encountered. Minor stroke was recorded in 1 procedure (1.6%). No early restenosis was recorded during follow-up (range, 1-35 months; mean, 15.6 months). Pathological examination revealed inter-intimal excision of the lesion in each case. Conclusion Microsurgical inter-intimal dissection could accomplish good surgical outcome, including absence of significant early restenosis.






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