• Tsutomu Ichinose, Kentaro Naito, and Takashi Tsuruno.
• Department of Neurosurgery, Yao Tokushukai General Hospital, Yao, Osaka, Japan. Electronic address: ichinose-t@tokushukai.jp.
• World Neurosurg. 2014 Jul 1;82(1-2):e225-8.

BackgroundSafe 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.MethodsTo 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.ResultsSixty-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.ConclusionMicrosurgical interintimal dissection could accomplish good surgical outcome, including absence of significant early restenosis.Copyright © 2014 Elsevier Inc. All rights reserved.

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