title: Microsurgical interintimal dissection in carotid endarterectomy.
abstract: BACKGROUND
  Safe and complete surgical excision of carotid plaque in carotid endarterectomy (CEA) is essential for preventing postoperative embolic stroke and restenosis. We considered the dissection plane for the plaque according to pathological findings of carotid atherosclerosis. We report our experiences with inner-intimal dissection in CEA.
  
  
  METHODS
  To obtain complete resection of the plaque with a smooth distal edge and bloodless surface by minimal exposure of the media, the thickened intima was sliced under high-magnification microscopy. The excised specimens were examined pathologically.
  
  
  RESULTS
  Sixty-three CEAs were performed for 61 patients with carotid stenosis. Complete resection without tacking suture was obtained in all procedures. No mortality was encountered. Minor stroke was recorded in 1 procedure (1.6%). No early restenosis was recorded during follow-up (range, 1-35 months; mean, 15.6 months). Pathological examination revealed interintimal excision of the lesion in each case.
  
  
  CONCLUSIONS
  Microsurgical interintimal dissection could accomplish good surgical outcome, including absence of significant early restenosis.
authors: Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan. Electronic address: ichinose-t@tokushukai.jp.
authors: Tsutomu
authors: T
authors: Ichinose
authors: Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan.
authors: Kentaro
authors: K
authors: Naito
authors: Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan.
authors: Takashi
authors: T
authors: Tsuruno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000209:etiology / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology / Q000601:surgery
keywords: Carotid endarterectomy; Dissection; Pathology