The internal carotid artery supplies the anterior brain, eye, and anterior pituitary. Its course through the carotid canal and cavernous sinus creates the carotid siphon — visible on cerebral angiography. ICA stenosis from atherosclerosis at the origin (bulb) produces the majority of thromboembolic strokes — carotid endarterectomy (CEA) or stenting reduces stroke risk in symptomatic stenosis greater than 50%.
| Origin | Common carotid artery bifurcation at the C3-C4 level (upper border of the thyroid cartilage) |
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Carotid endarterectomy targets the ICA bifurcation atherosclerotic plaque through a neck incision, removing the intima and plaque under shunted blood flow. NASCET trial established benefit for symptomatic ICA stenosis greater than 70% (and some benefit for 50-69%). Carotid artery stenting is an alternative in high-surgical-risk patients.
Atherosclerotic internal carotid artery stenosis producing TIA and stroke risk managed with carotid endarterectomy or stenting for symptomatic stenosis over 50%.
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