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Internal carotid artery

Internal carotid artery

INTERNAL CAROTID ARTERY
The following is from Bouthillier's 1996 classification scheme:
Cervical segment
    • Ascends from the carotid bifurcation through the carotid space to the carotid canal.
Petrous segment
    • Rises and passes forward within the carotid canal.
Lacerum segment
    • Exits the carotid canal and rises to the cavernous sinus.
Cavernous sinus segment
    • Rises within the cavernous sinus, then passes forward through it, and then rises out of the cavernous sinus, where it becomes the clinoid segment.
Clinoid segment
    • Curves posteriorly.
Ophthalmic segment
    • Passes posteriorly and gives off the ophthalmic artery, which traverses anteriorly through the optic canal.
Communicating segment
AAN Practice Parameter
Summary
  • Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A).
  • Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with <50% stenosis (Level A).
  • For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made.
Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (<3%) (Level A). Low dose aspirin (81 to 325 mg) is preferred for patients before and after carotid endarterectomy to reduce the rate of stroke, myocardial infarction, and death (Level A).
Reference
"Carotid endarterectomy—An evidence-based review Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology." Neurology September 27, 2005 vol. 65 no. 6 794-801 Reaffirmed on February 9, 2008 and April 30, 2014.

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