eMedicine Specialties > Vascular Surgery > Medical Topics

Atherosclerotic Disease of the Carotid Artery: Multimedia

Author: Niten Singh, MD, Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Chief of Endovascular Surgery, Madigan Army Medical Center
Coauthor(s): Sean D O'Donnell, MD, Director, Department of Surgery, Section of Vascular and Endovascular Surgery, Washington Hospital Center; David L Gillespie, MD, FACS, RVT, DMCC, COL, MC, USA Chief and Program Director, Vascular Surgery Service, Walter Reed Army Medical Center; Professor of Surgery, Uniformed Services University of the Health Sciences; Vascular Surgery Consultant, Office of the US Army Surgeon General; James M Goff, MD, Assistant Chief, Department of Surgery, Walter Reed Army Medical Center; Assistant Professor, F Department of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Jan 8, 2009

Multimedia

Arteriogram of the aortic arch and its branches.Media file 1: Arteriogram of the aortic arch and its branches.
Arteriogram of the aortic arch and its branches.

Arteriogram of the aortic arch and its branches.

Arteriogram of a carotid stenosis.Media file 2: Arteriogram of a carotid stenosis.
Arteriogram of a carotid stenosis.

Arteriogram of a carotid stenosis.

Atherosclerotic plaque removed at the time of car...Media file 3: Atherosclerotic plaque removed at the time of carotid endarterectomy (areas of ulceration with thrombus and intraplaque hemorrhage present).
Atherosclerotic plaque removed at the time of car...

Atherosclerotic plaque removed at the time of carotid endarterectomy (areas of ulceration with thrombus and intraplaque hemorrhage present).

Carotid artery exposed prior to carotid endartere...Media file 4: Carotid artery exposed prior to carotid endarterectomy (coil present in the internal carotid artery).
Carotid artery exposed prior to carotid endartere...

Carotid artery exposed prior to carotid endarterectomy (coil present in the internal carotid artery).

Carotid artery following endarterectomy and prior...Media file 5: Carotid artery following endarterectomy and prior to closure (tapered endpoint and smooth appearance of the lumen).
Carotid artery following endarterectomy and prior...

Carotid artery following endarterectomy and prior to closure (tapered endpoint and smooth appearance of the lumen).

Carotid artery following Dacron patch angioplasty.Media file 6: Carotid artery following Dacron patch angioplasty.
Carotid artery following Dacron patch angioplasty.

Carotid artery following Dacron patch angioplasty.

Selective left carotid angiogram.Media file 7: Selective left carotid angiogram.
Selective left carotid angiogram.

Selective left carotid angiogram.

Oblique view of the left carotid artery demonstra...Media file 8: Oblique view of the left carotid artery demonstrating lesion within internal carotid artery.
Oblique view of the left carotid artery demonstra...

Oblique view of the left carotid artery demonstrating lesion within internal carotid artery.

Placement of stent into internal carotid artery. ...Media file 9: Placement of stent into internal carotid artery. Note filter wire in upper photos (dots at top of internal carotid artery).
Placement of stent into internal carotid artery. ...

Placement of stent into internal carotid artery. Note filter wire in upper photos (dots at top of internal carotid artery).

Angioplasty after stent placement; again, note fi...Media file 10: Angioplasty after stent placement; again, note filter wire protecting distal carotid artery.
Angioplasty after stent placement; again, note fi...

Angioplasty after stent placement; again, note filter wire protecting distal carotid artery.

Completion arteriogram displaying improvement in ...Media file 11: Completion arteriogram displaying improvement in diameter of internal carotid artery.
Completion arteriogram displaying improvement in ...

Completion arteriogram displaying improvement in diameter of internal carotid artery.

Normal carotid arteries on color flow duplex.Media file 12: Normal carotid arteries on color flow duplex.
Normal carotid arteries on color flow duplex.

Normal carotid arteries on color flow duplex.

Color flow duplex revealing an 80-99% left caroti...Media file 13: Color flow duplex revealing an 80-99% left carotid stenosis and a normal right carotid.
Color flow duplex revealing an 80-99% left caroti...

Color flow duplex revealing an 80-99% left carotid stenosis and a normal right carotid.

Carotid plaque.Media file 14: Carotid plaque.
Carotid plaque.

Carotid plaque.

More on Atherosclerotic Disease of the Carotid Artery

Overview: Atherosclerotic Disease of the Carotid Artery
Workup: Atherosclerotic Disease of the Carotid Artery
Treatment: Atherosclerotic Disease of the Carotid Artery
Follow-up: Atherosclerotic Disease of the Carotid Artery
Multimedia: Atherosclerotic Disease of the Carotid Artery
References

References

  1. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Aug 15 1991;325(7):445-53. [Medline].

  2. Canadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. The Canadian Cooperative Study Group. N Engl J Med. Jul 13 1978;299(2):53-9. [Medline].

  3. Halliday A, Mansfield A, Marro J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. May 8 2004;363(9420):1491-502. [Medline].

  4. Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol. Oct 2008;7(10):885-92. [Medline].

  5. Centers for Medicare and Medicaid Services. Available at www.cms.hhs.gov.

  6. Young B, Moore WS, Robertson JT, et al. An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators. Asymptomatic Carotid Artheriosclerosis Study. Stroke. Dec 1996;27(12):2216-24. [Medline].

  7. Wiesmann M, Schopf V, Jansen O, et al. Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. Eur Radiol. Dec 2008;18(12):2956-66. [Medline].

  8. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Nov 12 1998;339(20):1415-25. [Medline].

  9. Burton KR, Lindsay TF. Assessment of short-term outcomes for protected carotid angioplasty with stents using recent evidence. J Vasc Surg. Dec 2005;42(6):1094-100. [Medline].

  10. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. Jun 2 2001;357(9270):1729-37. [Medline].

  11. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. May 10 1995;273(18):1421-8. [Medline].

  12. Friedman SG. A History of Vascular Surgery. Mount Kisco, NY: Futura Publishing Co; 1989.

  13. Gurm HS, Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. Apr 10 2008;358(15):1572-9. [Medline].

  14. Hobson RW 2nd. Status of carotid angioplasty and stenting trials. J Vasc Surg. Apr 1998;27(4):791. [Medline].

  15. Hobson RW 2nd, Goldstein JE, Jamil Z, et al. Carotid restenosis: operative and endovascular management. J Vasc Surg. Feb 1999;29(2):228-35; discussion 235-8. [Medline].

  16. Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Jun 8 2000;342(23):1693-700. [Medline].

  17. Jackson MR, Chang AS, Robles HA, et al. Determination of 60% or greater carotid stenosis: a prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography. Ann Vasc Surg. May 1998;12(3):236-43. [Medline].

  18. Liapis C, Kakisis J, Papavassiliou V, et al. Hemostatic function and carotid artery disease. Int Angiol. Mar 2004;23(1):14-7. [Medline].

  19. Moore WS. Fundamental Considerations in Cerebrovascular Disease. In: Rutherford Vascular Surgery. 5th ed. Philadelphia, Pa: WB Saunders; 2000:1713-30.

  20. [Best Evidence] Ringleb PA, Allenberg J, Bruckmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. Oct 7 2006;368(9543):1239-47. [Medline].

  21. Wakhloo AK, Lieber BB, Seong J, et al. Hemodynamics of carotid artery atherosclerotic occlusive disease. J Vasc Interv Radiol. Jan 2004;15(1 Pt 2):S111-21. [Medline].

  22. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. Oct 7 2004;351(15):1493-501. [Medline].

Further Reading

Keywords

atherosclerotic disease of the carotid artery, carotid artery, atherosclerosis, stroke, transient ischemic attacks, TIAs, cerebral infarction, cerebral intermittent claudication, extracranial carotid disease, carotid plaque, angioplasty, endarterectomy, hypertension, carotid bruit, diabetes, smoking, atrial fibrillation, obesity, hyperlipidemia, homocysteine, embolization, artery blockage, artery

Contributor Information and Disclosures

Author

Niten Singh, MD, Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Chief of Endovascular Surgery, Madigan Army Medical Center
Niten Singh, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Coauthor(s)

Sean D O'Donnell, MD, Director, Department of Surgery, Section of Vascular and Endovascular Surgery, Washington Hospital Center
Sean D O'Donnell, MD is a member of the following medical societies: American College of Surgeons and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

David L Gillespie, MD, FACS, RVT, DMCC, COL, MC, USA Chief and Program Director, Vascular Surgery Service, Walter Reed Army Medical Center; Professor of Surgery, Uniformed Services University of the Health Sciences; Vascular Surgery Consultant, Office of the US Army Surgeon General
David L Gillespie, MD, FACS, RVT, DMCC, COL, MC is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Venous Forum, Eastern Vascular Society, Society for Vascular Surgery, and Southern Association for Vascular Surgery
Disclosure: Nothing to disclose.

James M Goff, MD, Assistant Chief, Department of Surgery, Walter Reed Army Medical Center; Assistant Professor, F Department of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences
James M Goff, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Richard M Stillman, MD, FACS, Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center
Richard M Stillman, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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