Carotid endarterectomy remains the treatment of choice for carotid stenosis in vascular surgery center which offers a low rate of complications and great results. In centers like ours where complications are less than 3% is the technique of choice in most cases.

Modalities such as eversion of the atheroma plaque, patch closure and remodeling of the carotid bulb regularly and combined with the best current medical treatment have made that restenosis of the treated artery was very low.

    Monitoring systems during surgery to detect brain hemodynamic changes during intervention, or measurement systems to check distal perfusion or embolic get minimizes the risk of cerebral ischemia. It could be useful shunt to minimize risk of hypoperfusion previous to clamp distal carotid.  Check video⇐

Performing local anesthesia (GALA trial) in endarterectomy has managed to treat by endarterectomy  patients with certain risk for anesthesia. However is important to select patients to this new anesteshic tecniques.

Other techniques such as reverse flow by carotid approach can arise in cases of anatomical difficulty to usual endovascular treatment .

Endarterectomy in case of  severe symptomatic stenosis should be performed after a TIA or minor stroke within the first weeks if there is a low risk of hemorrhagic transformation and  clinical stability. In cases of great clinical or radiological impairment after the first month you should consider whether you could benefit from endarterectomy and worth it.

The multidisciplinary approach with neurology and neuroradiology teams are useful in all cases, especially cases of recent stroke or TIA with anatomical difficulties or comorbidity.