Illustration depicting a<unk>  An incision is made on the midline side of the sternocleidomastoid muscle. The incision is between in length. The internal, common and external carotid arteries are carefully identified, controlled with vessel loops, and clamped. The lumen of the internal carotid artery is opened, and the atheromatous plaque substance removed. The artery is closed using suture and a patch to increase the size of the lumen. Hemostasis is achieved, and the overlying layers closed with suture. The skin can be closed with suture which may be visible or invisible (absorbable). Many surgeons place a temporary shunt to ensure blood supply to the brain during the procedure. The procedure may be performed under general or local anaesthesia. The latter allows for direct monitoring of neurological status by intra-operative verbal contact and testing of grip strength. With general anaesthesia, indirect methods of assessing<unk> rebral perfusion must be used. Electroencephalography (EEG), transcranial doppler analysis,<unk> rebral oximetry, or carotid artery stump pressure monitoring can guide the placement of a shunt, or a shunt may be routinely used. At present there is no good evidence to show any major difference in outcome between local and general anaesthesia, nor between methods of determining the need for a shunt.
Carotid endarterectomy
Carotid stenting
Endarterectomy
Angioplasty
Thrombectomy
Compression stockings
Electrothermal bipolar vessel sealing
Pulmonary thromboendarterectomy