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• Generally in patients with atherosclerotic disease, survival is dependent upon management of myocardial ischemia
•  Correlation has been demonstrated between, & internal carotid artery intimal wall thickness and coronary heart disease incidence
• Anesthetic management approach:
  1. prevent myocardial ischemia first
  2. prevent neurological events second
•  Surgical intervention to manage cerebrovascular insufficiency (e.g., carotid endarterectomy) is associated with noteworthy morbidity/mortality

Ultrasound:  Vascular Carotid Imaging (images:Agilent Technologies, http://www.healthcare.agilent.com/ultrasound/cgi-bin/img_gallery.pl

• Mild wall thickening: left common carotid (Left);  Mild wall thickening: internal carotid  (right)-- Clinical Presentation: a 69-year old man presented with transient episodes of left arm weakness; from Carotid Artery Stenosis by Thomas F. Gudas, M.D., and Benjamin Faitelson, M.D., 1994; http://brighamrad.harvard.edu/Cases/bwh/hcache/6/full.html

Carotid Artery Stenosis 

• (courtesy G.E. Imaging, http://www.gemedicalsystems.com/medical/ultrasound/msul7imv.htm)

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• Primary Reference: Katz, J.,  Evaluation Risk Assessment of Patients with Vascular Disease in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 201-218, 1998.