Lateral Position of the External Carotid Artery: A Rare Variation to Be Recognized During Carotid Endarterectomy

Ito, Masaki; Niiya, Yoshimasa; Kojima, Masashi; Itosaka, Hiroyuki; Iwasaki, Motoyuki; Kazumata, Ken; Mabuchi, Shoji; Houkin, Kiyohiro

doi:10.1007/978-3-319-29887-0_16

Cited by 12 publications

(26 citation statements)

References 8 publications

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“…Failure to detect these vascular anomalies preoperatively increases the risk of peri-and postoperative complications. [5] Here, we focused on the so-called twisted internal carotid artery (ICA), which runs medially to the external carotid artery (ECA). [3,4,7,10] is anomaly was also called "side-by-side carotid artery, " "dorsal/dorsomedial origin of the ICA, " or "lateral ECA. "…”

Section: Introductionmentioning

confidence: 99%

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Analysis of twisted internal carotid arteries in carotid endarterectomy

Honda¹,

Maeda²

2020

Surgical Neurology International

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Background: The twisted carotid artery is a variant, in which the internal carotid artery (ICA) courses medially to the external carotid artery. Due to the sparse descriptions in the literature, we, here, report our experience with cases of carotid endarterectomy (CEA) for twisted carotid artery and its clinical features. Methods: Fifty-seven consecutive CEA-treated patients were evaluated, and the twist angle was measured on the source images of axial slices of computed tomography angiography (CTA). Results: Eight male patients (14.2%) demonstrated a twisted right ICA (mean age, 77.0 ± 2.6 years; and mean stenosis, 66.9% ± 19.9%). The mean twist angle was 30.1° ± 17.9°, while the normal ICA is angled at −23.0° ± 12.3°. No statistical differences in the distribution of coexisting diseases were found between the normal and twisted ICA cases. CEA was successfully performed with the correction of the carotid position in all cases; however, significant position correction was not observed in the postoperative evaluation. Right-side dominancy (P = 0.045) and prolonged clamping time (P = 0.053) were observed in the twisted cases. Conclusion: Twisted ICA was preferentially found in the right ICA and men. CEA of the twisted ICA was safely performed with appropriate head rotation and wider longitudinal skin incision than usual without a significant increase in the operative time. CTA is useful for preoperative evaluation. This specific variation should be considered by the neurosurgeon involved in the evaluation and treatment of carotid stenoses.

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Section: Introductionmentioning

confidence: 99%

“…[3,4,7,10] is anomaly was also called "side-by-side carotid artery, " "dorsal/dorsomedial origin of the ICA, " or "lateral ECA. " [5,[12][13][14][15][16]20] Although several series and/or cases have been reported, we clarified the frequency and other clinical features of the twisted ICAs among our CEA-treated cases and…”

Section: Introductionmentioning

confidence: 99%

Analysis of twisted internal carotid arteries in carotid endarterectomy

Honda¹,

Maeda²

2020

Surgical Neurology International

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“…7,8) The frequency of TCB among our patients was 11.3% and it was significantly more prevalent on the right side. Angiography findings have shown that the incidence of TCB or LPECA in various diseases is 4.3%-4.9% in Japanese populations 10,12) and 3.6%-15.1% during CEA. [5][6][7][8]10,14,15) Therefore, this abnormality is actually quite prevalent.…”

Section: Discussionmentioning

confidence: 99%

“…However, the ICA sometimes runs medically to the ECA, which has been described as side-by-side carotid artery, 3) dorsal/dorsomedial origin of the ICA, 4) complete transposition of the carotid bifurcation (CB), 5) twisted carotid bifurcation (TCB), [6][7][8] lateral ECA, and lateral position of the ECA (LPECA). [9][10][11][12] Most recent reports of patients with TCB who have undergone CEA have focused on surgical techniques, and few describe diagnosing a TCB. 8,10) The present study aimed to determine the diagnostic features of a TCB and its surgical management and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Operative Management of Carotid Endarterectomy in Patients with Twisted Carotid Bifurcation

Uno

Yagi

Takai

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Although carotid endarterectomy (CEA) is an established procedure, technical modifications are required when anatomical features are unusual. The present study aimed to determine the characteristics of diagnostic features, surgical management, and outcomes of patients with a twisted carotid bifurcation (TCB). We assessed 108 consecutive patients by cervical carotid echography (CCE) and black-blood magnetic resonance imaging (BB-MRI) before they underwent 115 CEA procedures. We classified carotid bifurcation (CB) anatomy based on anteroposterior findings of the internal carotid artery (ICA) and external carotid artery (ECA) determined by cerebral or three-dimensional computed tomographic angiography as follows. The ICA and ECA ran laterally and medially, respectively, in Type 1, overlapped in Type 2, and the ICA and ECA ran medially and laterally, respectively, in Type 3. We also classified the patients according to whether or not they had a TCB and compared their diagnostic findings, clinical characteristics, and surgical outcomes. The numbers of patients with Types 1, 2, and 3 were 74 (64.4%), 32 (27.8%), and 9 (7.8%), respectively, and 13 (11.3%) with a TCB included four patients with Type 2 and all nine patients with Type 3. The appearance of Type 3 differed from that of the other two types on CCE and BB-MR images. After correcting the anatomical location of a TCB, surgical duration and adverse event rates did not significantly differ between patients with and without a TCB. Patients with a TCB could safely undergo CEA after correcting the ICA to the normal position.

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