Improved surgical technique for carotid endarterectomy.

Despite improved results following carotid endarterectomy, a small but significant incidence of neurological deficit may follow the operation. Emphasis has deviated from the importance of the technical details of the operative procedure to consideration of the role of physiological factors (e.g., shunt, stump pressure, EEG vigilance, type of anesthesia). The surgical principles outlined in this report were used in a consecutive series of 214 patients undergoing carotid endarterectomy. A neurological deficit was noted in two patients (0.9%) in whom thrombosis of the repair site was proven.