Chirurgie carotidienne - Lésions spécifiques

Indications for carotid surgery are infrequent but highly important for patients who present with some specific, non-atherosclerotic lesions. In case of carotid tortuosity, surgery can be considered only in symptomatic patients, provided it has been ascertained that no other cause exists for the observed symptoms. Most of the time, such tortuosity is accompanied by dysplastic parietal lesions that may turn to aneurysm or dissection. Surgical treatment consists in a calibration and re-implantation of the internal carotid artery, or a venous grafting in case of very severe parietal lesions. Dissections generally expand up to the base of the skull; surgery is exceptionally indicated. A wide aetiology characterises carotid aneurysms; they may be of dysplastic, post-dissection, or post-traumatic origin. Infectious and atherosclerotic aneurysms are far less frequent. Most of the time, they are localized in the upper part of the cervical internal carotid artery. Surgical treatment by venous grafting may be undertaken by a specific approach – generally performed in cooperation with ENT surgeons – that allows to reach the first intrapetrous segment of the artery.