[Intima flap of the external carotid and postoperative stroke in a patient surgically treated with thromboendarterectomy of the internal carotid].

Retrograde thrombosis of the carotid bifurcation rising from an intimal flap of the external carotid artery represent a rare complication of carotid surgery. We present the case of a patient who had undergone carotid thromboendarterectomy (TEA) whose postoperative course was complicated by the appearance of left hemiplegia and coscience disorders. The timely diagnosis of acute carotid thrombosis and the immediate reoperation prevented neurological deficits becoming settled. An attentive intraoperative evaluation of carotid bifurcation showed only the presence of an intimal flap of the external carotid artery from which a big occluding thrombus, involving the bifurcation, rose. The internal and common carotid arteries showed a successful result of the TEA and a good retrograde flow through the internal carotid artery. The authors underline the existence of this perioperative complication and the need for a timely recognition and treatment to avoid serious neurologic consequences.