ABSTRACT
This lateral angiographic view of a patient with carotid TIAs demonstrates a very tight stenosis (99%) at the takeoff of the ICA and the unusual finding of a long, ulcerated plaque in the CCA as well. In my experience, this kind of CCA plaque is seldom seen except in patients who have had radiation-induced carotid vasculopathy or in reoperative cases. This patient was considered an appropriate surgical candidate. The extent of the plaque in the CCA necessitated significantly different surgical planning. The cervical incision needed to be carried much lower along the anterior border of the sternocleidomastoid muscle, essentially down to the level of the sternal notch. The operative photograph demonstrates the extent of the arteriotomy in the CCA, which engendered a long arterial suture line. The carotid reconstruction was otherwise uneventful.
