ABSTRACT
When the ICA suture line has been brought down to the region of the carotid bulb, the 6-0 Prolene is secured with a rubber-shod mosquito clamp and draped away from the field. A second arm of the suture line is brought up from the CCA. This begins by taking a large full-thickness bite proximal to the apex of the arteriotomy in the CCA. The same type of equal bites are then taken to create a suture line that comes up until it meets the ICA suture line in the region of the carotid bulb. The bites in the CCA need not be as fine because the potential for creating a stenosis is much less. I customarily have the CCA suture line performed by the assistant since a right-handed assistant will place the bites from right to left just as the primary surgeon did in the ICA. In this way, the needles will come out on opposite sides of the vessel at the carotid bulb and the knot will lie across the arteriotomy wall rather than having both stitches on the same side. I think this is important to secure adequate hemostasis at the point where the two suture lines are brought together.
