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  • Asymptomatic carotid stenosis > 60% by angiography or 70% by duplex ultrasound.
  • Symptomatic carotid stenosis (cerebrovascular accident, transient ischemic attack, or amaurosis fugax) > 50%.
  • Carotid endarterectomy can be performed safely under regional anesthesia in patients with severe chronic obstructive pulmonary disease, coronary artery disease (CAD), and other comorbidities.
  • Carotid stenting can be considered in patients with a history of neck irradiation, modified radical neck dissection, or reoperative carotid endarterectomy.
  • Only patients with concurrent symptomatic carotid stenosis and symptomatic CAD should be considered for combined carotid endarterectomy and coronary artery bypass grafting.

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  • There are no absolute contraindications other than distal internal artery occlusion.

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  • The patient should be in a semi-seated position with a small roll across the shoulder blades.
    • This allows for gentle extension and external rotation of the head to the contralateral side.
  • The ipsilateral arm is tucked, padding the elbow and wrist.
  • Care should be taken not to over-rotate or extend the head to avoid kinking of the vertebral arteries or contralateral carotid artery.
  • Landmarks such as the ear lobe, angle of the mandible, mastoid process, sternal notch, and clavicle must be included in the prepared area.

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  • Closed suction drain overnight, depending on surgeon preference.
  • Strict postoperative management of blood pressure, avoiding hypertension to reduce the risk of hyperperfusion syndrome.
  • Discharge following overnight observation and monitoring (possibly 8 hours postoperatively if uncomplicated and with satisfactory blood pressure).

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  • Cranial nerve injury.
  • Stroke.
  • Myocardial infarction.
  • Carotid restenosis.

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