**Core Concept**
Atherosclerosis is a chronic, progressive disorder characterized by the accumulation of lipids, inflammatory cells, and fibrous elements within the arterial wall. This process involves the large and medium-sized arteries, but also affects small arteries and arterioles. The disease is marked by a complex interplay between lipid deposition, endothelial dysfunction, and inflammation.

**Why the Correct Answer is Right**
Option C states that atherosclerosis does not involve small arterioles. However, this is not accurate. Atherosclerosis can affect small arterioles, leading to their narrowing and eventual occlusion. The disease process involves the entire arterial tree, from large elastic arteries to small muscular arteries and arterioles. The involvement of small arterioles can lead to significant clinical consequences, including hypertension, ischemia, and organ dysfunction.

**Why Each Wrong Option is Incorrect**
**Option A:** Deposition of lipids on vessels is a true statement regarding atherosclerosis. Lipid accumulation is a hallmark of the disease, with cholesterol and triglyceride esters being deposited within the arterial wall.

**Option B:** Necrosis of vessels is not a primary mechanism of atherosclerosis. However, the disease can lead to vascular remodeling and eventually to aneurysm formation or rupture.

**Option D:** Atherosclerosis is indeed an inflammatory response to endothelial injury. The disease involves the activation of immune cells, such as macrophages and T-lymphocytes, which contribute to the inflammatory process and the progression of atherosclerosis.

**Clinical Pearl / High-Yield Fact**
Atherosclerosis is a systemic disease that affects multiple organ systems, including the cardiovascular, renal, and nervous systems. The disease is a major cause of morbidity and mortality worldwide, and its prevention and management require a comprehensive approach that addresses lifestyle modifications, risk factor control, and pharmacological interventions.

**✓ Correct Answer: C. Does not involve small arterioles**