الفهرس 
Anatomy of the carotid arteries in the neckOnly 14 pages are availabe for public view
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Abstract
Carotid endarterectomy is now considered worldwide to be the gold standard management of carotid artery stenosis to prevent stroke. Patients with symptomatic CAS may present by TIA, stroke or visual affection. Patients with asymptomatic CAS may present by audible neck bruit and palpable thrill upon routine examination. The pathology of plaques can be a determining factor for choice of treatment, plaques with ulcerations, calcification, inflammation and vulnerability all are contraindications for carotid stenting and are indications for endarterectomy. The main screening tool for investigating carotid artery stenosis is duplex ultrasound and the gold standard for diagnosis is carotid arteriography .Other imaging tools include CT angiography, spiral CT with 3D reconstruction and MRI imaging.
For carotid endarterectomy to be useful to patients and to achieve minimum periprocedural morbidity and mortality the following should be acknowledged : 1)Selection of patients(whose with stenosis 70% or more benefit the most from CEA) 2) Adequate preoperative studies to demonastrate stenosis, site and morphology of plaque, anatomy of the carotids. 3) Good preparation with antiplatelets and use of heparinized saline intra-operative. 4)Intra-operative monitoring for cerebral hypoperfusion. 5)Use of microscope aided dissection to preserve cranial nerves and avoid carotid bulb dennervation. 6) Employment of a shunt as nessecary to avoid cerebral hypoperfusion. 7)Closure with patch reduces risk of future restenosis. 8)order of removal of temporary clamps starting with the ECA then CCA and lastly the ICA, to drive residual debris to the ECA rather than the ICA. Complications of CEA are cranial nerve injuries, myocardial infarction, hyptotension, hyperperfusion and stroke. Endovascular carotid stenting and balloon angioplasty are other alternatives for those patients medically unfit or refusing surgery, as a main principle endovasular intervention for revascularization is better than no revascularization at all for carotid artery stenosis greater than 7o% In comparison carotid endarterectomy has a smaller incidence of peri-operative and long term stroke and death than carotid stenting, but has larger incidence of myocardial infarction and risk of cranial nerve injury. The risk of restenosis after stenting is greater than after carotid endarterectomy