• Tomomasa Kondo, Nakao Ota, Felix Göhre, Yu Kinoshita, Kosumo Noda, Hiroyasu Kamiyama, Sadahisa Tokuda, and Rokuya Tanikawa.
• Department of Neurosurgery and Stroke Center, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido.
• World Neurosurg. 2020 Apr 1; 136: e108-e118.

ObjectiveCarotid endarterectomy (CEA) for high cervical internal carotid artery stenosis is considered to be technically demanding because of the difficulty in dissecting the distal end. We report the surgical technique and outcome analysis of CEA for high cervical lesions.MethodsWe retrospectively analyzed the records of 98 patients treated by CEA from December 2013 to June 2018. The plaque positions rostral to the C2 vertebral level was defined as the high cervical lesions (n = 34). The surgical technique is to successfully expose the distal end, as follows: 1) extend the skin incision; 2) expose the great auricular nerve maximally; 3) dissect between the SCM and parotid gland fascia; 4) resect the internal deep cervical lymph nodes; and 5) retract the digastric muscle, hypoglossal nerve, and occipital artery.ResultsThere were 8 cases (high cervical group, 4 cases; non-high cervical group, 4 cases) of postoperative diffusion-weighted imaging high signal and 6 cases (high cervical group, 3 cases; non-high cervical group, 3 cases) of symptomatic ischemic lesion. Four cases belonged to the technique-related cerebral infarction group and 4 cases to the perioperative-related cerebral infarction (PRCI) group. High cervical lesion is not considered to be a risk factor for either PRCI (P = 0.610) or technique-related cerebral infarction (P = 0.610). The difference of the diastolic blood pressure between the preoperative period and the second postoperative day showed a risk factor of PRCI (P = 0.033).ConclusionsThe surgical outcomes for high cervical lesions are equivalent to that of non-high cervical lesions. Excessive blood pressure management from the early postoperative days is a risk of PRCI.Copyright © 2019 Elsevier Inc. All rights reserved.

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