Extended Approach of Carotid Endarterectomy for High Cervical Lesions

Carotid endarterectomy (CEA) is the main treatment for the cervical internal carotid artery stenosis, which is an important cause of transient ischemic attacks and strokes. The operation requires careful attention to technical details, and certain specific principles are essential to achieve a consistently favorable outcome. It is important to expose the distal internal carotid artery adequately to permit direct visualization of the entire extent of an atherosclerotic plaque. An anatomical understanding of the deep cervical fascia of which carotid sheath consists helps to achieve a successful removal of plaque for high cervical lesions. The deep cervical fascia fuses with the periosteum along the superior nuchal line of the occipital bone, over the mastoid process and along the entire base of the mandible. Between the angle of the mandible and the anterior edge of sternocleidomastoid muscle, the fascia is particularly strong. However, this should be dissected thoroughly to expose the internal carotid artery as high as the entrance of carotid canal. These procedures allow a good approach to the high-positioned carotid stenosis.