Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ 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. ++ There are no absolute contraindications other than distal internal artery occlusion. ++ 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. ++ 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). ++ Cranial nerve injury.Stroke.Myocardial infarction.Carotid restenosis. Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.