Routine completion angiography and intraoperative stent placement for the management of distal intimal flap during eversion carotid endarterectomy

Although eversion carotid endarterectomy (CEA) has gained popularity, there are some concerns, including difficulties in handling the distal intimal flap, especially in those patients with a high lesion. Therefore, intraoperative angiography is routinely performed during CEA to check for intimal flaps and to assess the need for adjunctive maneuvers such as stent placement. We describe our adjunctive intraoperative carotid artery stenting after eversion CEA for unsatisfactory distal internal carotid artery end points detected by routine completion angiography. By conducting completion angiography when in doubt and adjunctive carotid artery stenting if indicated, the potential disadvantage of eversion CEA can be minimized.