ABSTRACT
The carotid bifurcation is just in front of the body of the C5 vertebra and the plaque does not ascend higher than the C4-5 disc space. Difficulties can arise with an exposure at this low level, where the carotid artery dives deep to the sternocleidomastoid and omohyoid muscles. The arteriogram was interpreted by an outside radiologist to be a complete carotid occlusion and the patient was sent home without any consideration of surgery. There are several radiographic characteristics of a stump that support this diagnosis and point the surgeon toward consideration of a stump repair. 3D-CTA is very useful to check the access routes from the femoral to the carotid arteries to evaluate the anatomical risk of CAS. The 3D-CTA and 3D-DSA are also useful to determine the size of stent and distal filter before CAS by quantifying the diameters of the CCA and the ICA at the most stenotic site and distal to the plaque.
