الفهرس 
ANATOMY OF THE CAROTID ARTERIESOnly 14 pages are availabe for public view
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Abstract
Atherosclerotic plaques are the most commonly encountered cerebral circulatory lesions associated with ischemic strokes and they cause an even higher incidence of transient cerebral ischemic symptoms. Atherosclerotic cerebral plaques are frequently associated with atherosclerotic lesions in other regions of the body; therefore decision is often required as to whether a single therapeutic modality will suffice to treat the underlying vascular disorder or whether individual organ systems threatened by ischemia must be dealt with individually, combining medical with surgical therapies (Robert et al., 2004).
Focal cerebral ischemic disease, or stroke, is responsible for 4.5 million deaths worldwide, with the majority occurring in nonindustrialized countries. The incidence of stroke is 0.2% per year in general population, but rises significantly with concurrent risk factors, age, sex, and ethnic background (Alan et al., 2006).
Carotid artery stenosis is classified as either asymptomatic or symptomatic based on whether there are symptoms or signs of carotid territory ischemia in the ipsilateral eye or hemisphere. In the CEA clinical trials, symptomatic carotid disease was defined as the presence of transient monocular blindness (TMB), TIA, or stroke. Symptoms or findings suggestive of a carotid atheroma include carotid bruit, transient or fixed neurological symptoms referable to the internal carotid distribution (homonymous hemianopia, hemisensory deficit, hemimotor deficit, hemisensorimotor deficit, aphasia, neglect, apraxia, dysarthria), or TMB (Karen et al., 2004).
The investigations done to diagnose carotid atherosclerosis include: lab studies (CBC, lipid profile …) and imaging studies (ultrasound, MRA, CTA….) (Karen et al., 2004).
Medical management of carotid artery disease begins with modification of risk factors, including smoking cessation, control of diabetes, and reduction of cholesterol. Treatment of hypertension reduces the risk of stroke but caution should be exercised in patients with high-grade hemodynamically carotid stenosis because hypotension can evoke cerebra ischemia. Platelet anti-aggregation therapy with low-dose aspirin (30–283mg daily) has been shown to reduce the incidence of stroke in asymptomatic patients with coronary artery disease and in patients with TIA (Rodney et al., 2005).
On the other hand surgical treatment include: carotid endarterectomy and carotid angioplasty and stenting
Carotid endarterectomy is most commonly performed by opening the carotid artery longitudinally and removing the plaque, the artery is then closed primarily or with a patch. Alternatively the internal carotid artery is transected obliquely at its origin and the endarterctomy is performed using an eversion technique (Jamal et al., 2003).
In recent years successful eversion carotid endarterectomy has produced excellent results prospective randomized series have shown that eversion carotid endarterectomy has lower occlusion and restenosis rates when compared to standard carotid endarterectomy. We have measured arterial diameter of the internal carotid artery beyond the atheromatous plaque before and after carotid endarterectomy and have found that the internal carotid artery diameter increases invariably by an average of 1mm, this is in contradistinction to the usual decrease in diameter by the distal suture line when conventional closure of the arteriotomy is done (Christopher et al., 2000).