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“High” ICA Lesions Technical Adjuncts - Exposure

“High” ICA Lesions Technical Adjuncts - Exposure. “High” ICA Lesions Technical Adjuncts - Exposure. Divide the ansa-hypoglossal nerve Release and reflect the hypoglossal nerve anteriorly Divide the digastric muscle Reflect vagus anteriorly superior to nodose ganglion.

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“High” ICA Lesions Technical Adjuncts - Exposure

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  1. “High” ICA LesionsTechnical Adjuncts - Exposure

  2. “High” ICA LesionsTechnical Adjuncts - Exposure • Divide the ansa-hypoglossal nerve • Release and reflect the hypoglossal nerve anteriorly • Divide the digastric muscle • Reflect vagus anteriorly superior to nodose ganglion

  3. “High” ICA LesionsTechnical Adjuncts - Long Tongue of Plaque • Do not do a blind distal endarterectomy • Make decision to leave tongue of plaque before taking endarterectomy to end of arteriotomy • Either tack down end point ~ 1/2 cm from end of the arteriotomy and patch,or reconstruct with a bypass beveled over tongue

  4. Summary-Technical Adjuncts • Cardiac - Block carotid sinus, give atropine • CEA+CAB - CEA with vein harvest, drain • Contralateral occlusion - Shunt • Hostile Neck - friable artery, vein patch or bypass • High ICA Lesion - Exposure (hypoglossal, diagastic, vagus), reconstruction (patch, bypass)

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