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      Do Asians have Higher Carotid Bifurcation? A Computed Tomographic Angiogram Study of the Common Carotid Artery Bifurcation and External Carotid Artery Branching Patterns

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          Abstract

          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.

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          Most cited references29

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          Anatomical variations of the common carotid artery bifurcation.

          The correlation of the common carotid artery (CCA) bifurcation and its surrounding structures is poorly described. The aim of this study was to describe the anatomy of the CCA bifurcation relative to its surrounding structures. We dissected a total of 67 carotid specimens from 36 embalmed cadavers. CCA bifurcation occurred at the superior border of thyroid cartilage in 39% and at the body of hyoid bone in 40% of specimens. The superior thyroid artery arose more commonly from the CCA (52.3%) than the external carotid artery (46.2%). The vagus nerve was posterior to the carotid bifurcation in 40 (60%), posterior-lateral in 24 (36%), posterior-medial in 2 (3%) and anterior-lateral in 1 specimen (1.5%). The hypoglossal nerve was closer to the CCA bifurcation when the CCA bifurcated at the level of the hyoid bone than when it bifurcated at the superior border of the thyroid cartilage (P < 0.05). The correlation of the common facial vein and the carotid artery was highly variable. The presence of a high CCA bifurcation should caution surgeons that the hypoglossal nerve lies in closer proximity and is more vulnerable. Preoperatively documenting the level of the CCA bifurcation may be helpful in identifying those patients at increased risk of iatrogenic injury.
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            Variations of the great arteries in the carotid triangle.

            The variations of the common carotid artery, as well as of the external and internal carotid arteries, are described. During anatomic dissection on adult cadavers, we investigated the variability of appearance of 40 carotid arterial systems. Special consideration was given to the topographic relations such as the level of the bifurcation of the common carotid artery, the relationship between the external and internal carotid arteries, and the origin of the great collateral branches. Special attention was paid to the origin of the superior thyroid artery. In this article the practical importance of these variations is stressed.
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              Anatomical variations of the superior thyroid and superior laryngeal arteries.

              There are known to be variations in the origins of the superior thyroid artery (STA), an important surgical landmark, and 1 of its branches, the superior laryngeal artery (SLA). Three hundred thirty human embalmed heminecks were dissected. The results of previous studies were reviewed, and a meta-analysis is presented. Four different origins for the STA were found. The most frequent was type I, from the carotid bifurcation (49%). Four different origins were also found for the SLA being the most frequent the type I in which the artery arose from STA (78%). The mean external diameters of STA and SLA were 0.26 and 0.20 cm, respectively, with no statistically significant differences by side or sex. Variations in the origin of STA and SLA from the carotid arterial tree and the similarity of their diameters mean that there is a significant possibility of their misidentified during surgery. Copyright 2009 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Asian J Neurosurg
                Asian J Neurosurg
                AJNS
                Asian Journal of Neurosurgery
                Wolters Kluwer - Medknow (India )
                1793-5482
                2248-9614
                Oct-Dec 2019
                25 November 2019
                : 14
                : 4
                : 1082-1088
                Affiliations
                [1] Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
                [1 ] Department of Neuroradiology, Prasat Neurological Institute, Bangkok, Thailand
                Author notes
                Address for correspondence: Dr. Ekkapot Jitpun, Department of Neurosurgery, Prasat Neurological Institute, 312, Ratchawithi Road, Thung Phayathai, Ratchathewi, Bangkok 10400, Thailand. E-mail: ejitpun@ 123456gmail.com
                Article
                AJNS-14-1082
                10.4103/ajns.AJNS_162_19
                6896614
                31903344
                17cee61b-27b9-459f-adba-cc01289b84be
                Copyright: © 2019 Asian Journal of Neurosurgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Surgery
                carotid anatomy,carotid bifurcation level,carotid endarterectomy,computed tomographic angiogram carotid study,extracranial carotid branching patterns

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