Stroke is diagnosed one half million times each year and consumes a tremendous amount of medical resources, costing over fifteen billion dollars a year. In the early 1990's several well-designed studies clearly demonstrated the advantage of carotid endarterectomy over medical therapy in selected patients. Success of this surgery depends not only on patient selection but surgeon selection since the advantage of surgery is present only if the surgeon has a low incidence of complications such as stroke.

Anatomy and Physiology

• Blood leaving the heart enters the aorta, the main central artery of the body (Figure 1)
  
• The first arterial branches off of the aorta are the innominate artery (also called the brachiocephalic trunk), left common carotid artery and the left subclavian artery
  
• The innominate artery gives rise to the right common carotid and subclavian arteries. In the neck the common carotid arteries branch into the internal and external carotid arteries, the internal carotid arteries extending upwards in the front of the neck to feed the front of the brain including the frontal, parietal and temporal lobes (see Craniotomy). The vertebral arteries on each side pass upwards in the back of the neck to feed the back part of the brain
  

Figure 1 - Arteries leading from the aorta to the internal carotid arteries