Carotid endarterectomy for high plaques.

Seventeen instances of high plaque (plaque extending up to the level of the second cervical vertebra) were encountered out of a total of 454 carotid endarterectomies (3.7 percent). With careful dissection and knowledge of anatomy superior to hypoglossal nerve, carotid endarterectomy was accomplished without resorting to mandibular subluxation or dislocation. There was no operative mortality or perioperative strokes. One patient had perioperative myocardial infarction and another sustained temporary glossopharyngeal nerve dysfunction. High carotid plaques were more common in male patients with bilateral stenoses or contralateral internal carotid occlusion and could be suspected by findings of preoperative carotid arteriography in some instances. In the majority of cases, extension of high plaque in a tongue-shaped manner on the posterior wall of the internal carotid artery was an unexpected finding at the time of carotid endarterectomy.