The internal carotid artery supplies the anterior two-thirds of the cerebral hemisphere via the middle and anterior cerebral arteries and the eye via the ophthalmic artery. Carotid atherosclerotic stenosis at the bifurcation produces thromboembolic strokes and TIAs — carotid endarterectomy (CEA) or stenting (CAS) reduces stroke risk in symptomatic stenosis greater than 50% and asymptomatic greater than 60-70%.
| Origin | Common carotid artery bifurcation at the C3-C4 level (upper border of the thyroid cartilage) |
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Carotid endarterectomy removes the atheromatous plaque from the carotid bifurcation and ICA proximal segment — the most evidence-based vascular surgical procedure for stroke prevention. The shunt maintains ICA flow during cross-clamping. Patch closure (Dacron or vein patch) reduces restenosis rates compared to primary closure. CEA achieves stroke risk reduction superior to best medical therapy for symptomatic stenosis greater than 70%.
ICA atheromatous stenosis producing TIA and stroke managed with CEA or CAS for symptomatic stenosis greater than 50%.
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