Carotid Endarterectomy with Plication

Carotid endarterectomy (CEA) remains the standard surgical treatment for patients with significant carotid artery stenosis, with the primary goal of preventing ischemic stroke by removing atherosclerotic plaque and restoring normal blood flow. Achieving optimal outcomes requires careful dissection, precise endarterectomy, and meticulous arterial closure, all of which are essential for minimizing perioperative complications. Carotid plication is a surgical technique performed during CEA to correct arterial redundancy and kinking that may persist after plaque removal. By folding and suturing the redundant arterial segment without resection, the technique preserves luminal integrity and physiologic arterial length while reducing flow turbulence and the associated risk of thrombosis. This approach provides anatomical straightening and reliable restoration of blood flow, offering a simple and durable alternative to resection with end-to-end anastomosis, particularly in patients with tortuous or elongated internal carotid arteries. In this video article, we demonstrate the fundamental steps and key principles of CEA and present a representative case in which carotid plication was performed to correct redundancy of the internal carotid artery.