Anatomical Considerations on Surgical Anatomy of the Carotid Bifurcation

Abstract

Surgical anatomy of carotid bifurcation is of unique importance for numerous medical specialties. Despite extensive research, many aspects such as precise height of carotid bifurcation, micrometric values of carotid arteries and their branches as their diameter, length, and degree of tortuosity, and variations of proximal external carotid artery branches are undetermined. Furthermore carotid bifurcation is involved in many pathologic processes, atheromatous disease being the commonest. Carotid atheromatous disease is a major predisposing factor for disabling and possibly fatal strokes with geometry of carotid bifurcation playing an important role in its natural history. Consequently detailed knowledge of various anatomic parameters is of paramount importance not only for understanding of the disease but also for design of surgical treatment, especially selection between carotid endarterectomy and carotid stenting. Carotid bifurcation paragangliomas constitute unique tumors with diagnostic accuracy, treatment design, and success of operative intervention dependent on precise knowledge of anatomy. Considering those, it becomes clear that selection and application of proper surgical therapy should consider anatomical details. Further research might ameliorate available treatment options or even lead to innovative ones.

An Anatomical Variation in the Cervical Carotid Artery of a Young Stroke Patient

“…There have been several reports on rare anatomical variations of the cervical carotid artery (1)(2)(3)(4)(5). These abnormalities were considered to be congenital and to develop during angiogenesis (6, 7); furthermore, they have been considered to be incidental and were not known to cause stroke.…”

“…Several anatomical variations of the cervical carotid artery have been found, especially in the carotid bifurcation (1)(2)(3)(4)(5). However, these variations have been considered as cervical carotid artery anomalies and have not implicated in ischemic or hemorrhagic stroke.…”

Variations in carotid sinus anatomy and their relevance to carotid interventions

“…This influences where optimal surgical incisions should be made [11]. The branches of the carotid arteries, diameters and degree of tortuosity also vary and have important relevance for clinical interventions [12,13] .…”

Variations, relations and clinical significance of carotid arterial system in anterior neck: a cadaveric study

“…The common carotid artery (CCA) usually bifurcates into external carotid artery (ECA) and internal carotid artery superior thyroid artery (STA), lingual artery (LA) and facial artery (FA) arise directly from front of ECA within anterior triangle of neck. 1,2,4,5,9,10,12,[16][17][18][19][20][21][22][23] These branches arising from front of ECA are especially important during chemoembolization and neck reconstruction surgeries during surgical management of head-neck tumors. 9 Neck has a complex and variable anatomical relationship between many important structures and these knowledge is crucial in numerous surgical interventions including carotid endarterectomy, carotid stenting, vascular embolization, neck tumor surgeries, plastic reconstruction of neck following removal of large mass, radical neck dissections, carotid sinus baroreceptor stimulation to avoid unwanted structural damage and related complications.…”

“…1,2,4,5,9,10,12,[16][17][18][19][20][21][22][23] These branches arising from front of ECA are especially important during chemoembolization and neck reconstruction surgeries during surgical management of head-neck tumors. 9 Neck has a complex and variable anatomical relationship between many important structures and these knowledge is crucial in numerous surgical interventions including carotid endarterectomy, carotid stenting, vascular embolization, neck tumor surgeries, plastic reconstruction of neck following removal of large mass, radical neck dissections, carotid sinus baroreceptor stimulation to avoid unwanted structural damage and related complications. 9,18,22,24 Moreover, the anatomy and geometry of CCA may influence the carotid atherosclerosis which is a leading cause of death and disability.…”