ABSTRACT
In this case I had completed the internal carotid repair with Hemashield patch grafting. On final auscultation (after declamping), the Doppler signal from the ECA was highpitched consistent with persistent stenosis. Fortunately a shunt had not been required. The clamps were re-applied and the ECA was opened over a short distal segment and residual plaque was removed. Following this strategy, as previously illustrated, a primary ECA repair without patch graft was performed, although in this case it did not extend back to the carotid bulb.
