“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
“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