Carotid Endarterectomy in High Cervical Internal Carotid Artery Stenosis Using Mandibular Traction with a Wire

Abstract

High cervical internal carotid artery stenosis (ICS) is considered a high-risk factor treated with carotid endarterectomy (CEA). Mandibular subluxation is among several methods available to perform CEA in cases with high cervical ICS. We report a case of high cervical ICS that was treated with a CEA carried out using mandibular traction with a wire. Our patient was an 80-year-old man with symptomatic right ICS. The distal plaque end of the ICS was at the upper edge of the second cervical vertebral arch and vulnerable plaque was suspected. A percutaneous wire was passed through the tip of the mandible and the mandible was then pulled. This method enabled exposure of the surgical field around the distal internal carotid artery and our surgical procedure became easier. This method is useful for CEA in cases with high cervical ICS.