Certain drugs can reduce the risks associated with atherosclerosis. These include statins, which reduce the level of cholesterol and fat in the blood, as well as anticoagulants and other drugs such as aspirin , which prevent formation of blood clots. In large arteries such as the aorta or carotids, sections obstructed by atheromas can be removed surgically and replaced with synthetic materials. Atherosclerotic plaques can also be removed from the carotid circulation by atherectomy, in which the fatty deposits are carefully removed by a tiny knife inserted into the vessel via a catheter. In the case of occluded coronary arteries, the lives of countless cardiac patients have been saved by coronary bypass surgery , in which sections of blood vessels from other parts of the body are used to route blood flow around the obstructions. Some occlusions can be opened by balloon angioplasty , in which a catheter is inserted to the site of obstruction and a balloon is inflated in order to dilate the artery and flatten the plaque deposits. Passages opened in this way frequently reclose over time, but the chances of this occurring can be reduced significantly by the insertion of expandable wire-mesh stents as part of the angioplasty procedure. Some stents are “drug-eluting,” that is, coated with a drug that inhibits the kind of cell growth that leads to reclosure.
Alternatively, the caudal vertebral body superior articulating process (SAP) contributes to lateral recess and foraminal stenosis (see the image below). Indeed, facet hypertrophy between L4 and L5 vertebrae may impinge the L4 nerve root in the foramen and the L5 proximal nerve root sheath in the lateral recess. The 2 lower motion segments (L3-L4, L4-L5) are most commonly affected by degenerative stenosis. These segments are in a transition zone from the rigid sacrum to the mobile lumbar spine. In addition, the posterior joints in this area have less of a sagittal orientation, which affords more rotation and are therefore more vulnerable to rotatory strains.
Chronic rhinosinusitis represents a multifactorial inflammatory disorder, rather than simply a persistent bacterial infection.  The medical management of chronic rhinosinusitis is now focused upon controlling the inflammation that predisposes patients to obstruction, reducing the incidence of infections. However, all forms of chronic rhinosinusitis are associated with impaired sinus drainage and secondary bacterial infections. Most individuals require initial antibiotics to clear any infection and intermittently afterwards to treat acute exacerbations of chronic rhinosinusitis.