ABSTRACT
This single AP radiograph of a CCA injection was taken on the third postoperative day. The dilation of the arterial repair from plaque removal with a thin residual arterial wall can readily be seen. This arteriogram was performed when the patient experienced a single postoperative transient ischemic attack, and dissection of the ECA is demonstrated. This dissection is the consequence of inadequate plaque removal in the ECA at the time of arteriotomy and arterial repair. As mentioned earlier in the text, I do not hesitate at present to perform a separate ECA arteriotomy and endarterectomy when I am dissatisfied with marsupialization of the plaque from the ECA. When this is not done and a plaque remnant is left behind with a loose leading edge, an arteriogram such as this can be the consequence. Although in most cases this is a benign occurrence and has not been considered justification for reoperation, I am familiar with one case in which an ECA dissection led to thrombosis of the common and internal carotid arteries 10 days postoperatively, followed by a major and irreversible stroke. I have thus developed a very low threshold for ECA arteriotomy and repair, and this technique is illustrated in Figs. 3-57 to 3-61, 3-69 to 3-70, and 3-79.
