Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3660_Библиотеки_им_академика_М_И_Перельмана

This gure is an example of a false plane that can develop in the process of opening the ICA lumen. The Peneld No. 4 retractor is situated in the true lumen of the vessel, and it can be seen that the Potts Scissors went through the atheroma of a false plane and eventually burst into the true lumen in the ICA. There are no untoward con­sequences from a false dissection of this type in opening the vessel; however, it should be emphasized that the surgeon must ascertain the true lumen of the ICA either by direct inspection or visualization of backbleeding before any attempt at shunt placement.

A focal tight stenosis at the carotid bulb is shown. There is no extensive plaque either down the CCA or up the ICA, making this a relatively simple and straightforward exposure and plaque removal. However, the brown, discolored area of carotid plaque indicates the presence of intra-plaque hemorrhage and an active plaque that no doubt was responsible for the patient’s symptoms. This is type of soft, friable plaque that is so often associated with intra-plaque hemorrhage.

Shown is a long atherosclerotic plaque that extends far down the CCA and also a good distance up the ICA. The repair involved a time-consuming, extensive arteriotomy; otherwise the operation was straightforward. I thought it was important in this case to take the CCA arteriotomy low enough for all ulcerated areas of the plaque to be removed.