ABSTRACT
Marsupialization of the plaque from the ECA is usually sufficient to ensure a clean break-off. However, if fragments can be palpated or a rough edge can be demonstrated on inspection of the endarterectomized ECA with a curved clamp, I do not hesitate to open the ECA with a separate arteriotomy that begins at the carotid bifurcation, extends straight up the ECA, and is performed in the same fashion as the ICA arteriotomy, creating a Y-shaped arteriotomy defect that needs to be closed in that manner. Inattention to detail in the performance of the ECA endarterectomy can be the source of thrombus formation and later embolization up the ICA, or it may lead to a dissection of the ECA (illustrated in Fig. 2-21), which may ultimately cause thrombosis of the entire carotid tree with devastating consequences for the patient.
