Damage does not occur at the tip of the flow divider, but rather just distal to the divider. There are unique features of the CCA bifurcation. The common carotid artery has a higher flow rate which is unlike other arteries whose flow rate varies more widely in relation to blood supply needs. Secondary Plaque Changes 1. Surface erosion, probably caused by extreme turbulence of blood flow, leads to the formation of an ulceration which is a favourite site for the formation of small platelet thrombi.
Calcification contributes to the loss of elasticity of the arterial wall.
Arterial wall changes . Inner layers of the media dependent on diffusion from the lumen for their viability. Intimal plaque poses barrier to diffusion which in turn leads to necrosis of smooth muscle cells and degeneration of the elastic fibers. Wall is weakened by the loss of muscle cells and elastic fibers, and may stretch resulting in ectasia or even mild fusiform aneurysm formation. Plane of cleavage during endarterectomy lies at the junction between plaque and surrounding media.