Reflections on the Carotid Artery: 438 BC to 2009 AD

This essay has 2 objectives. First, it summarizes the publication of the reports that have been scattered through the literature since the largest of the definitive trials have appeared dealing with extracranial carotid stenosis. Second, it discusses the major differences that have been noted between the design and conduct of the large trials.The carotid arteries, the paired vessels delivering most of the blood to the brain, have been the subject of many observations from Grecian times to the present. The Greeks in 438 BC recognized the importance of these neck vessels. The Parthenon in Athens depicted in marble an attempt by a centaur to kill a soldier by bilateral manual compression of the neck arteries.The carotid arteries were pictured by Vesalius. They were most elaborately described with their branches and the effects of their occlusion by Thomas Willis of Oxford in 16641 (Figure 1). In 1612, Samuel Champlain, the founder of Canada, was engaged in a battle with hostile Iroquois and a stone-tipped arrow pierced his ear, grazed his face, and entered his neck stopping, as described by his definitive biographer, “just short of his carotid artery.”2 Figure 1. The home of Thomas Willis in Merton Street, Oxford built in the 17th century. Henry Barnett and Alastair Buchan, November 2008.Shakespeare’s literary and drinking companion, Christopher Marlowe, died (1593) in a London pub of hemorrhage after a stabbing through the eye into the intracranial site of the carotid artery. All this was recently translated from the Latin in the rediscovered write-up of his postmortem examination3 (Figure 2). In the Toronto medical school from which I graduated in 1944, we learned of the carotid artery in anatomy, but in my clinical undergraduate years, it never was mentioned in relation to stroke. Figure 2. Marlow’s knife went …