Indications

• TIAs in distribution of artery (middle/anterior cerebral territory)

Preparation

• Carotid duplex: extent of stenosis
• Carotid angiogram
• Echo, cholesterol, ECG, CT brain (previous CVA)

Procedure

1. Local anaesthetic block / intercostal block (allows monitoring of neurological status intra-operatively) - enables operation without a shunt
2. GA allows for better airway control, requires shunt + EEG
3. Incision over sternocleidomastoid (oblique)
4. Dissect down to common carotid, external, internal carotid
5. Tape looped around external carotid for control
6. Heparin infused, longitudinal arteriotomy into carotid distal to site of stenosis
7. Plaque removed distal to proximal in one piece
8. Close arteriotomy with graft/patch (avoid problems of stenosis) with full thickness sutures (+ removal of shunt) + irrigate with heparinised saline

Complications

• Nerve injury - recurrent laryngeal, hyoglossal (12) nerve
• Haematoma
• Hypertension / hypotension (carotid body effects)
• Stroke (1-5%)

Follow up

• 6 month surveillance scans