Carotid endarterectomy for high risk patients

Internal carotid artery stenosis is a systemic vascular disease that is frequently complicated with hypertension, diabetes mellitus, obesity, ischemic heart disease and arteriosclerosis obliterans. Patients undergoing hemodialysis are also frequently complicated with internal carotid artery stenosis. To determine individual indications for carotid endarterectomy, carotid artery stenting, and medical treatment based not only on internal carotid stenosis but also on systemic vascular disease is important and strict perioperative management is required to prevent postoperative complications in high-risk patients. We describe the problems associated with carotid endarterectomy among high-risk patients and their management.