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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1082-1088
DOI: 10.4103/ajns.AJNS_162_19
Original Article

Do asians have higher carotid bifurcation? A computed tomographic angiogram study of the common carotid artery bifurcation and external carotid artery branching patterns

Ekkapot Jitpun
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
,
Yodkhwan Wattanasen
1   Department of Neuroradiology, Prasat Neurological Institute, Bangkok
,
Wuttipong Tirakotai
Department of Neurosurgery, Prasat Neurological Institute, Bangkok
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Introduction: Carotid endarterectomy is a major treatment modality for high-grade carotid stenosis. Preoperative identification of the level of the carotid bifurcation and its branching pattern is important in planning for adequate exposure and cross-clamping to achieve hemostasis during the procedure. Most of the previous studies on carotid arteries were performed in cadavers. Methods: We studied levels of carotid bifurcation compared relatively with the level of the vertebral body and ipsilateral angle of the mandible and its branching pattern using computed tomographic angiogram (CTA) carotid with multiplanar reconstruction and three-dimensional imaging in 100 CTA studies. Results: Most of the carotid bifurcations were located at the level of C3–C4 vertebral body and 12% were considered to be high bifurcation. Carotid bifurcations were located below the angle of the mandible in 83.5%. The superior thyroid, facial, and lingual arteries arose from separate branches of external carotid arteries in 67.7% of samples. Facial arteries arose in common trunk with lingual arteries in 29.2%, much more common than previous cadaveric studies. The lingual arteries arose with superior thyroid arteries in 2%, while occipital arteries had high variations in their branching patterns. Conclusions: CTA is an effective and reliable modality for preoperative evaluation of the carotid system in patients undergoing carotid endarterectomy and other carotid procedures. Higher percentage of high carotid bifurcation was found in our study, concordant with other Asian cadaveric studies. We assumed that carotid bifurcation of Asian tends to be located slightly higher than those of the Caucasian population.

Key-words:

Carotid anatomy - carotid bifurcation level - carotid endarterectomy - computed tomographic angiogram carotid study - extracranial carotid branching patterns

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Spetzler RF, Baskin JJ, Apostolides PJ. Rational and Protocol for Microsurgical Carotid Endarterectomy, Microsurgical Carotid Endarterectomy. Philadephia, New York: Lippincott-Raven; 1996.
  • 2 Bademci G, Batay F, Tascioglu AO. Non-traumatic elevation techniques of the hypoglossal nerve during carotid endarterectomy: A cadaveric study. Minim Invasive Neurosurg 2005;48:108-12.
  • 3 Bademci G, Batay F, Vural E, Avci E, Al-Mefty O, Yaşargil MG, et al. Microsurgical anatomical landmarks associated with high bifurcation carotid artery surgery and related to hypoglossal nerve. Cerebrovasc Dis 2005;19:404-6.
  • 4 Kim T, Chung S, Lanzino G. Carotid artery-hypoglossal nerve relationships in the neck: An anatomical work. Neurol Res 2009;31:895-9.
  • 5 Devadas D, Pillay M, Sukumaran TT. A cadaveric study on variations in branching pattern of external carotid artery. Anat Cell Biol 2018;51:225-31.
  • 6 Anu VR, Pai MM, Rajalakshmi R, Latha VP, Rajanigandha V, D'Costa S, et al. Clinically-relevant variations of the carotid arterial system. Singapore Med J 2007;48:566-9.
  • 7 Dessie MA. Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve. PLoS One 2018;13:e197075.
  • 8 Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S, et al. Anatomical variations of the common carotid artery bifurcation. ANZ J Surg 2006;76:970-2.
  • 9 Lucev N, Bobinac D, Maric I, Drescik I. Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg 2000;122:590-1.
  • 10 Natsis K, Raikos A, Foundos I, Noussios G, Lazaridis N, Njau SN, et al. Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature. Clin Anat 2011;24:699-705.
  • 11 Hayashi N, Hori E, Ohtani Y, Ohtani O, Kuwayama N, Endo S, et al. Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir (Tokyo) 2005;45:25-9.
  • 12 Klosek SK, Rungruang T. Topography of carotid bifurcation: Considerations for neck examination. Surg Radiol Anat 2008;30:383-7.
  • 13 Chaijaroonkhanarak W, Prachaney P. The common carotid artery: Site of bifurcation at the vertebral level. Srinagarind Med J 2003;18:21-6.
  • 14 Ito H, Mataga I, Kageyama I, Kobayashi K. Clinical anatomy in the neck region the position of external and internal carotid arteries may be reversed. Okajimas Folia Anat Jpn 2006;82:157-67.
  • 15 Sanjeev IK, Anita H, Ashwini M, Mahesh U, Rairam GB. Branching pattern of external carotid artery in human. J Clin Diagn Res 2010;4:3128-33.
  • 16 Al-Rafiah A, EL-Haggagy AA, Aal IH, Zaki AI. Anatomical study of the carotid bifurcation and origin variations of the ascending pharyngeal and superior thyroid arteries. Folia Morphol (Warsz) 2011;70:47-55.
  • 17 Denli Yalvac ES, Balak N, Atalay B, Bademci MS, Kocaaslan C, Oztekin A, et al. A new method for determining the level of the carotid artery bifurcation. J Craniofac Surg 2019. doi: 10.1097/SCS.2701832701835449.
  • 18 McNamara JR, Fulton GJ, Manning BJ. Three-dimensional computed tomographic reconstruction of the carotid artery: Identifying high bifurcation. Eur J Vasc Endovasc Surg 2015;49:147-53.
  • 19 Weaver K, Huang J, Tamargo RJ, Bernard EJ Jr. Preoperative localization of the carotid bifurcation for carotid endarterectomy using magnetic resonance angiography without tomography: Technical note. Neurosurgery 2004;55:1227.
  • 20 Clemente CD. Anatomy, a Regional Atlas of the Human Body. 37th ed. Edinburgh: Churchill Livingstone; 1997.
  • 21 Kurkcuoglu A, Aytekin C, Oktem H, Pelin C. Morphological variation of carotid artery bifurcation level in digital angiography. Folia Morphol (Warsz) 2015;74:206-11.
  • 22 Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Edinburgh: Churchill Livingstone; 2008.
  • 23 Sinnatamby C. Last's Anatomy: Regional and Applied. Eginburgh: Churchill Livingstone, Elsevier; 2011.
  • 24 Moore KL, Daly AF, Agur AM. Clinically Oriented Anatomy. Philadephia, PA: Lippincott Williams and Wilkins; 2010.
  • 25 Drake RL, Vogl AW, Mitchell AW. Gray's Anatomy of Student. 2nd ed. Philadephia, PA: Churchill Livingstone; 2010.
  • 26 Ellis H, Mahadevan V, Clinical Anatomy: A Revision and Applied Anatomy for Clinical Students. Oxford, UK: Blackwell Publishing; 2010.
  • 27 Vázquez T, Cobiella R, Maranillo E, Valderrama FJ, McHanwell S, Parkin I, et al. Anatomical variations of the superior thyroid and superior laryngeal arteries. Head Neck 2009;31:1078-85.
  • 28 Ongeti KW, Ogeng'o JA. Variant origin of the superior thyroid artery in a Kenyan population. Clin Anat 2012;25:198-202.
  • 29 Mirjalili SA, McFadden SL, Buckenham T, Stringer MD. Vertebral levels of key landmarks in the neck. Clin Anat 2012;25:851-7.