Surgical Technique of Carotid Endarterectomy for High Cervical Carotid Artery Stenosis: Tips to Avoid Lower Cranial Nerve Injury

During the CEA (carotid endarterectomy) for carotid stenosis in high-risk patients, surgical technical problems and perioperative management problems exist. High-positioned stenosis is one high-risk factor. However, if the distal end of the plaque exists at the second cervical level, CEA is feasible by the usual skin incision with under some conditions: general anesthesia by nasal intubation, lifting up the carotid sheath with fishhooks to maintain a shallow operative field and keeping all manipulation in the carotid sheath, sharp dissecting close to artery to avoid the superior pharyngeal nerve injury, cutting ansa cervicalis in the early operating stage, moving the main trunk of external carotid artery, and using internal shunting systems. Here, we introduce our surgical technique.