Cerebrovascular disease

Stroke is the third leading cause of death in the United States. Approximately 500,000 people develop new strokes each year, making stroke the leading cause of neurological disability. Survivors of stroke account for $29 billion annually in healthcare costs and lost productivity. Despite this enormous clinical problem, during the past 50 years there has been tremendous progress in reducing mortality from stroke. This success in part is related to the evolution of the surgical treatment of extracranial cerebrovascular disease. Carotid endarterectomy (CEA) is the primary treatment used, and the frequency with which this procedure is performed has steadily increased since the early 1990s. Currently, CEA is the most commonly performed peripheral vascular operation in the United States. In this chapter, the anatomy, pathophysiology, diagnosis, and treatment of cerebrovascular disease are reviewed.