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Insufficient exposure at the distal site of the internal carotid artery is often encountered in carotid endarterectomy, especially when the lesion is high beyond the second vertebral body (C2) or atheromatus thickened intima continue to the far distal region. Previously reported fixative materials like strings or clips restrict the operative field in such cases. We conducted a new fixative method of internal carotid shunt at the distal internal carotid artery in carotid endarterectomy. We prepared a Sugita fenestrated clip, silicone tube used in CSF shunt and an internal shunt. A Pruitt-Ihanara carotid internal shunt is fixed in the usual manner using the tape at the common carotid artery but is fixed by the prepared Sugita clip from the proximal side at the distal internal carotid artery. This method provides at least 10-15 mm far distal operative field. In addition, the distal flap can be easily stripped or sutured.
