الفهرس 
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Abstract
Stroke is considered as the third leading cause of death nationally, and extracranial carotid artery stenosis represent 20 – 30 % of causes of stroke. Atherosclerosis accounts for about 90 % of the lesions of the extracranial carotid artery.
Patients with carotid artery stenosis can be classified into three categories : asymptomatic patients, patients with transient ischemic attack (TIA) and patients with cerebral stroke.
The first test usually done on patients for possibility of narrowing of carotid arteries is a Duplex scan. 2D MRA is the ideal MRA for differentiating a sub-occlusion from complete occlusion. 3D MRA is the preferred method for determining the degree of stenosis. Angiography has been perceived to be gold standard for determining the severity of carotid stenosis, but provides no hemodynamic information and a little reliable information on plaque morphology. Spiral CT angiography is non invasive vascular imaging technique in which angiographic images are produced by performing 3D display or reformation of vessel anatomy.
There are many modalities of treratment of carotid artery stenosis and its complication: conservative treatment including antiplatelet anticoagulants, surgical management namely carotid endarterectomy, or more recently percutaneous transluminal angioplasty and stenting.
Carotid endarterectomy is the gold standard surgical procedure done. It became one of the most commonly performed vascular procedures. Carotid endarterectomy can be performed under either local or general anaesthesia. Shunts should be used if the patient develop manifestation of cerebral ischemia.
Endarterectomy of the extracranial carotid artery has a proven track record for safe and reliable preservation of neurological function (NASCET Collaborators 1991). However, recurrent stenosis (<50%) may occur in up to 24% of patients undergoing standard bifurcation endarterectomy.
Eversion carotid endarterectomy is an attractive alternative to conventional CEA. It has the advantages of patch angioplasty in preventing restenosis without potential risks of prolonged cerebral ischemia or the need to use a ptach.
Endovascular techniques have revolutionized the treatment of vascular diseases, and such innovations as balloon angioplasty, stenting, and endoluminal grafting have changed treatment strategies for vascular disease considerable in recent years. The management of extracranial arterial disease is not likely to be an exception, and many published results of angioplasty and stenting in the carotid already are encouraging. There has been considerable interest in recent years in performing carotid angioplasty, with or without stenting, instead of carotid endarterectomy in patients with asymptomatic or symptomatic carotid artery stenosis.
the technical success rate of carotid endovascular procedure generally is excellent and continues to improve as new device designs and delivery techniques reduce the risk for procedural complication still further, the incidence of neurologic complications remains higher one would like them to be in some series.
carotid stent placement can be performed safely and effectively in patients with high risk anatomy for carotid endarterectomy and with morbidity and mortality rates comparable to those of carotid endarterectomy with a low restenosis rate.