Closure of the internal carotid artery after endarterectomy: The advantages of patch angioplasty without its disadvantages

We present an original technique which precludes narrowing of the internal carotid artery after simple closure of a longitudinal arteriotomy for endarterectomy. Derived from the technique used to treat excess length of the internal carotid artery, this procedure includes the following steps: (1) division of the internal carotid artery at its base; (2) slitting the carotid artery until reaching the distal part of the plaque; (3) endarterectomy of the internal carotid and common carotid-external carotid axis; and (4) reimplantation of the internal carotid into its ostium, enlarged to the new size of the divided carotid artery. It has been possible to use this technique in eight consecutive cases. Postoperative arteriograms and duplex scanning have shown that anatomic and functional results were excellent. Presently, this technique has our preference in the surgical treatment of atheromatous stenoses of the internal carotid artery.