A review of techniques used for the successful performance of carotid endarterectomy

Stroke remains a major medical problem because of its high rate of morbidity and mortality. Atherosclerotic disease of the carotid artery continues to be a contributing factor in many strokes. The effectiveness of carotid endarterectomy (CEA) for patients with carotid occlusive disease, with or without neurological symptoms, has been substantiated by several studies. Although patients likely to experience the benefit of decreased stroke risk from CEA have been identified, there are a variety of specific technical details in performing the surgery that may help to decrease the stroke risk of the procedure itself. Meticulous attention to the fundamental techniques in the performance of a CEA is the primary means of reducing operative risk and is discussed here. In addition, the role of several divergent techniques proposed to further reduce operative risk, such as the type of anesthesia, the type of incision, the use of intraoperative shunting, the method of vessel closure, the use of the operating microscope, and the use of eversion versus conventional endarterectomy technique is reviewed.