ABSTRACT
Before beginning the repair of the arteriotomy, it is necessary to inspect the bed of the carotid plaque for any loose fragments that might need to be removed. Failure to attend to this detail may result in free fragments of material in the arterial lumen, which can create the nidus for thrombus formation and subsequent embolization. I prefer to gently stroke the denuded area with a small peanut sponge, which brings up any loose edges, particularly if the stroking is done in a caudad to cephalad direction. Fragments should be grasped with the vascular forceps and peeled off in circumferential fashion. If the removal process is begun either in the center of the vessel or on one edge, the fragment will peel off in a circular fashion until it reaches the other edge of the arteriotomy. It is important to avoid further traumatizing of the denuded area.
