Figure 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
Content may be subject to copyright.
The artistic rendering illustrates the classification of the occipital artery into three common variations. O1: The occipital artery arose between superior thyroid artery and lingual artery; O2: The occipital artery arose between lingual artery and facial artery; and O3: The occipital artery arose above the level of the facial artery
Source publication
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 arter...
Context in source publication
Context 1
... branches were classified as A1, superior thyroid, facial, and lingual arteries arose from separate branches of external carotid arteries; A2, facial arteries arose in common trunk with lingual arteries (linguofacial trunk) and A3, lingual arteries arose with superior thyroid arteries (thyrolingual trunk) [ Figure 1]. Occipital arteries branching patterns were classified as O1, occipital arteries arose between superior thyroid arteries and lingual arteries; O2, occipital artery arose between lingual arteries and facial arteries and O3, the occipital arose above facial arteries [ Figure 2]. ...
Similar publications
Background
Research has shown that carotid intima-media thickness (CIMT) could help to predict carotid plaque (CP) progression in patients with mild carotid stenosis. However, the debate continues as to the value of carotid intima thickness (CIT) in monitoring the development of CP in patients with severe carotid stenosis. This study sought to eval...
Objective
Transcarotid artery revascularization (TCAR) is thought to be a promising technique and instrument for treating carotid stenosis with favorable outcomes. Since there remain several differences in anatomic characteristics among races, this study was conducted to investigate the anatomic eligibility of TCAR in Chinese patients who underwent...
The carotid artery is one of the major arteries in the circulatory system which supplies blood to brain, face and neck region of the body. Among the population geometry of carotid artery will be varying based on the ethnicity, height and gender. The Common Carotid Artery (CCA) will be branching into Internal Carotid Artery (ICA) supplies blood to b...
Objective: We selectively place carotid shunting when ipsilateral mean stump pressure is less than 40 mmHg during carotid endarterectomy (CEA). This study aimed to assess the validity of our selective shunting criterion by 1D-0D hemodynamic simulation technology.
Materials and Methods: We retrospectively reviewed 88 patients (95 cases) of CEA and d...
A 58-year-old man presented with a right hemispheric transient ischemic attack from recurrent common carotid artery (CCA) in-stent restenosis. He had undergone prior neck radiation for carcinoma of the right tonsil and subsequent right carotid endarterectomy (10 years prior) and right CCA stenting (5 years prior), all for symptomatic radiation-indu...
Citations
... Nevertheless, high-level carotid bifurcation (HCB) could lead to difficult surgical access during CEA to approach and treat this plaque because of restricted CB exposure [4,5]. In the presence of HCB, adjacent structures such as the hypoglossal nerve, which provides motor innervation to the tongue [6][7][8][9][10], as well as the marginal mandibular, recurrent laryngeal, and accessory nerves, and the sympathetic chain [1] and submandibular gland [2], could be injured during CEA. Consequently, the "high" and "low" positions of CB, carry significant relevance as they could necessitate modifications in the suitable surgical approach, potentially influencing the choices between CEA and carotid artery stenting (CAS) [2,11,12]. ...
... In the presence of HCB, adjacent structures such as the hypoglossal nerve, which provides motor innervation to the tongue [6][7][8][9][10], as well as the marginal mandibular, recurrent laryngeal, and accessory nerves, and the sympathetic chain [1] and submandibular gland [2], could be injured during CEA. Consequently, the "high" and "low" positions of CB, carry significant relevance as they could necessitate modifications in the suitable surgical approach, potentially influencing the choices between CEA and carotid artery stenting (CAS) [2,11,12]. ...
... There remains an absence of agreement on the identification of a definitive anatomical landmark that could serve as a marker for HCB. The literature offers a spectrum of definitions; many studies have described HCB as a CB that resides higher than the body of the third cervical vertebra (C3) [2,[13][14][15]. Alternatively, some research recommends the superior border of the thyroid cartilage [8,[16][17][18], the lamina of the thyroid cartilage [19], the hyoid bone [8,[16][17][18]20], or a position within the first quartile of the HCB distribution within 5 cm of the mastoid process [17] as potential markers. ...
Although high-level carotid bifurcation (HCB) could lead to notable surgical difficulty, the definitive reference point for HCB is unclear. HCB is typically characterized as carotid bifurcation (CB) located higher than the level of the third cervical vertebra (C), however, a major obstacle regarding carotid artery surgical exposure is angle of the mandible (AM). The objective of this study was to investigate CB level, define HCB in relation to AM and vertebral levels, and measure the vertical distance from HCB to ipsilateral AM. Moreover, the percentage of surgically challenged CBs, misclassified as low CBs (LCB) based on vertebral level, was investigated. Patients who underwent neck computed tomography angiography were retrospectively studied. HCBs were classified into two categories: CBs above the C3 and either at or above the ipsilateral AM. Of 172 CBs (86 patients; 57 men, 29 women), CB was mostly found at C3 (44.19%), whereas AM was commonly located at C2 (51.16%). Based on vertebral level and AM, HCBs were detected in 10.47% and 20.35% of CBs, respectively. The association of HCBs determined by either C3 or AM between both sides in each individual was nonsignificant (p>0.05), but HCBs determined by C3 level were predominant in women (OR = 3.58, 95%CI = 1.31–9.80). Considering both C3 and AM, there was 8.72% of HCBs. The remaining 91.28% was classified as LCBs, including 11.63% of CBs located at both C3 and AM which were actually classified as HCBs if determined by AM. In cases of CBs above AM level, the mean vertical distance was as high as 6.56 ±2.41mm.
... However, the reproducibility of measuring CIMT in the internal carotid artery, carotid bulb, and common carotid artery is lower compared to measuring only the common carotid artery site 32 . One reason is that in Japanese individuals, compared to Western populations, the carotid bifurcation often lies higher than the angle of the mandible 33 , making evaluations of the internal carotid artery and carotid bulb more challenging. Therefore, considering the potential issues with reproducibility, we decided to assess IMT based only on the common carotid artery. ...
INTRODUCTION
Epidemiological evidence regarding the relationship between smoking and secondhand smoke (SHS) exposure and carotid intima-media thickness (CIMT) has been limited in Asian populations. Employing baseline data from the Aidai Cohort Study, Japan, we evaluated the evidence in this cross-sectional study.
METHODS
Study subjects were 727 men aged 35–88 years and 1297 women aged 34–85 years. Information on smoking, SHS exposure, and confounders was obtained through a self-administered questionnaire. An automated carotid ultrasonography device was used to measure the right and left CIMT. The greatest CIMT measurement in the left or right common carotid artery was considered the maximum CIMT, and a maximum CIMT >1.0 mm was indicative of carotid wall thickening. Age, alcohol consumption, leisure time physical activity, hypertension, dyslipidemia, diabetes mellitus, body mass index, waist circumference, employment, and education level were adjusted at one time.
RESULTS
The prevalence of carotid wall thickening was 13.0%. The prevalence of never smoking was 30.5% in men and 90.1% in women. Among those who had never smoked, the prevalence of never SHS exposure at home and work was 74.3% and 48.2% in men and 38.3% and 56.3% in women, respectively. Active smoking and pack-years of smoking were independently positively related to carotid wall thickening regardless of sex, although the association with current smoking in women was not significant. Independent positive relationships were shown between former smoking and pack-years of smoking and maximum CIMT in men but not in women. No significant relationships were found between SHS exposure at home and work and carotid wall thickening or maximum CIMT in either men or women.
CONCLUSIONS
Active smoking, especially pack-years of smoking, was positively associated with carotid wall thickening in both sexes. Such positive associations with maximum CIMT were found only in men; however, interactions between smoking and sex were not significant.
... Although earlier research found several anatomical variances at the CCB level and in the ECA branches, the majority of those studies were still conducted on cadavers. Computed tomography angiography (CTA) was employed in fewer following research to delineate these variations [5,7,8]. ...
... Results from earlier studies have brought up the concern that different ethnic groups have varied incidences of these variations, and they vary greatly between populations. Compared to other populations, Asians showed higher levels of bifurcation [8,9]. ...
... Appropriate knowledge of anatomical variations in the CCB level and ECA branches is essential for head and neck surgeries. The risk of hypoglossal nerve injury increases when the CCB level is high during endarterectomy [1,8]. ...
Background
The common carotid bifurcation level is an important surgical landmark during head and neck surgery, especially endarterectomy, that could be omitted in patients with high bifurcation levels to reduce damage to neighboring structures like the hypoglossal nerve. Additionally, having a thorough understanding of the variations in the external carotid artery branches is crucial for head and neck cancer surgeries and thyroidectomy. However, cadavers were employed in the majority of studies on these variations. In previous research, there were significant disparities in the incidence of these variations according to gender, laterality, and ethnicity. In order to identify these changes in Egyptian patients and to compare them in terms of gender and laterality, we used computed tomographic angiography.
Methods
The level of the common carotid bifurcation was assessed in a cross-sectional study utilizing computed tomographic angiography, which included 80 patients (160 carotid sides) for comparing the common carotid artery bifurcation level with the relevant vertebrae and anterior neck structures, and they were compared with regard to gender and laterality. Variations in the external carotid artery branches were also evaluated.
Results
The most frequent location of the common carotid bifurcation level was between C3 and C4 (33.8%). It was 36.9% between the thyroid and the hyoid. 47.5% of patients had a high common carotid bifurcation (higher than the C3/4 level). The highest bifurcation was at C2, while the lowest was at D1. For external carotid artery branches variations, the superior thyroid artery emerged at and below the level of the common carotid bifurcation, respectively, at 19.4% and 23.7%. The facial artery had the largest diameter (2.38 ± 0.44 mm), while the ascending pharyngeal artery had the smallest (1.17 ± 0.11 mm). Seven types of trunks were found; the ascending pharyngeal artery-occipital artery trunk was the most common (25%) and was followed by the lingual artery-facial artery trunk (20%).
Conclusions
Multiple anatomical variations in the external carotid artery branches and the common carotid bifurcation level were found by computed tomographic angiography. As a result, it can be utilized as a useful imaging technique to evaluate these variations before surgery.
... Previous studies have reported that type II (TLT) occurs in 1 to 3% of cases [3,[5][6][7][8][21][22][23][24][25]. In our study, we also observed a prevalence of 1%, which is consistent with the literature. ...
Background: The aim of this study was to identify variations in the origins of the anterior branches of the external carotid artery (ECA) and to propose an update of the current classification. Methods: The study included 100 carotids arteries from fifty human donors. Classification of anterior branches of external carotid artery was performed according to Vaz'quez et al. (2009). Results: The configuration origins of anterior branches were found as follows: Type I, 82%; Type II, 1%; Type III, 16%. No Type IV was observed. The study identified seven subgroups of anterior branch variations in the external carotid artery. The most frequently observed variations were Subtype Ia in 40% (n = 20) of cases on the right side and Subtype Ib in 38% (n = 19) on the left side. In addition, a rare and previously unclassified configuration was observed in a 72-year-old male donor, where the carotid artery was pentafurcated on the left side. Conclusions: In conclusion, the presence of anatomical variants not previously included in the anterior external carotid artery branching classifications supports the consideration of a revision to the present classification system.
... The right side is more statistically significant than the left side (p >0.05). The findings correlated with the previous literature [39][40][41][42][43][44][45][46][47][48][49][50][51]. The data of the present study compared with previous literature are shown in Table 2. Normally, the ECA terminates at the level of the neck of the mandible into superficial temporal and maxillary arteries. ...
Introduction:
The prime source of vascularization to the head and neck region is through the carotid arteries. The terminal branches of common carotid arteries, such as external carotid artery (ECA) and internal carotid artery (ICA), and their branches are crucial due to the wide area of distribution and variations in their branching pattern. The branching pattern and morphometry are essential for surgeons in the planning and execution of head and neck surgeries. Therefore, this study was conducted to observe the branching patterns of ECA and analyze them morphometrically.
Materials and methods:
This retrospective study includes 100 CT images, inclusive of 32 females and 68 males. The branching pattern and luminal diameter of CCA and ECA were measured and analyzed statistically.
Results:
The luminal diameter of CCA in males were as follows: 7.4 ± 1.01 (R), 7.1 ± 0.8 (L), and in females: 7.3 ± 0.9 (R), 7 ± 0.9mm (L); and the luminal diameter of ECA in males: 5.2 ± 1.0mm (R), 5.2 ± 0.9mm (L), and in females: 5.0 ± 0.9mm (R), 5.1 ± 1.0mm (L). The level of the carotid bifurcation and ECA branching pattern was observed, and variations were commonly seen in the superior thyroid artery (STA), lingual artery (LA), and facial artery (FA). Conclusion: The findings of the present study with regard to the external carotid artery and its branching pattern correlate with previous studies. The most common variations were observed in the superior thyroid and lingual and facial arteries. Knowledge about the morphology and branching pattern of the carotid artery is essential for procedures such as intra-arterial chemotherapy, carotid artery stenting, endarterectomy, and extra-intra cranial bypass revascularization procedure where it is harvested as a donor's vessel.
... CTA, magnetic resonance angiography or conventional angiography images obtained from ECA and CB are usually used for planning and performing these procedures [14]. Recently, it has been reported that 3D reconstruction images are often more advantageous than 2D ones because 3D reconstruction images may offer better and more detailed visualizations from different aspects for surgeons, radiologists, and other specialists to diagnose more accurately and perform procedures more safely [5,24,29]. ...
... These results are similar to the those reported by Herrera-Núñez et al. [12], Devadas et al. [8] and Zümre et al. [31]. However, Özgür et al. [22] (90%), Hayashi et al. [10] (81%), and Natsis et al. [21] (80.1%) reported higher type I prevalence, and Jitpun et al. [14] and Shintani et al. [26] reported (65.5%) lower type I prevalence than we did. ...
... As far as surgical treatment is concerned, ligation of the LA or TLT may be useful to prevent excessive hemorrhage in oral and oncologic surgeries [3]. Earlier studies found the incidence of a TLT described as type II to range from 1 to 3% [1,3,6,7,10,11,14,21,22,31]. Our series found the prevalence of this variation to be very close to that reported in the literature (2%). ...
Purpose:
The aim of our study was to determine the variations of the anterior branches of the external carotid artery (ECA) and investigate the morphometric and geometric features of the anterior branches of the ECA and carotid bifurcation (CB).
Methods:
A total of 563 ECAs were included from 288 patients in the study. Classification and exit angles of anterior branches of ECA and determination of vertebral levels of CB and anterior branches were performed.
Results:
The anterior branch variants of the ECA were observed in 8 different subgroups. The most common variations were type Ia 42.3% (n = 120) on the right and type Ib 40.9% (n = 114) on the left. When looking at the vertebral levels, CB was detected at C4 level in 32.9% of total ECAs (n = 185), STA was at C4 level in 33.4% of total ECAs (n = 188), LA was at C3 level in 50.1% of total ECAs (n = 282), and FA was at C2 level in 37.3% of total ECAs. The mean CB angle in all cases was 59.93° ± 16.04. In the anterior branches of the ECA in cases belonging to the Type I group, the widest angle belonged to FA (R = 116.88 ± 27.04°, L = 110.32° ± 25.94).
Conclusion:
In conclusion, a new classification of the variations of the anterior branches of the ECA was made on the basis of the CTA images to gain more practicality in surgical procedures. This study revealed for the first time the angular and level relationship between CB and ECA anterior branches.
... There are individual differences in the position of common carotid artery(CCA).It is known that the most common level of bifurcation of CCA occurs at the superior border of thyroid cartilage(C3-4 cervical vertebrae) [1][2][3]. Intrathoracic bifurcation of CCA is a rare vascular anomaly,with only 14 cases reported in the previous literature.As far as we know,this is the rst case of an intrathoracic bifurcation of the left common carotid artery accompanied with severe stenosis of the bilateral proximal middle cerebral artery. The diameter of right ICA was 5 mm and left one was 2 mm. ...
... There are individual differences in the position of CCA.It is known that the most common level of bifurcation of CCA occurs between C3 and C5 vertebral,but uncommon locations can also appear,such as higher levels C1-2 or lower levels C6-7 [1][2][3]. Intrathoracic bifurcation of the CCA is a very rare anatomic variant.There are several literature reports correlated with intrathoracic bifurcation.Intrathoracic CCA bifurcation was unilateral in ten cases and bilateral in four cases [4][5][6]. Level of bifurcations ranged between T1 and T4 . ...
Background
The bifurcate position of the common carotid artery is protean. It is most often locating between the C3 and C5 vertebral levels.Intrathoracic bifurcation of common carotid artery is a rare anatomic finding,and an association with bilateral segmental severe stenosis of middle cerebral artery has not been reported in the past literature .we report a case of low bifurcation of the left common carotid artery associated with Klippel–Feil syndrome and severe stenosis of the bilateral proximal middle cerebral artery.
Case Presentation
A 47-years old woman presented with dizziness and sleep disturbance,whose computed tomography angiography image incidentally revealed an intrathoracic bifurcation of the left common carotid artery associated with bilateral segmental severe narrowing of middle cerebral artery（MCA）.The left transverse process and spinous process of C3-4 fused and posterior arch of atlas did not fuse on Volume rendered（VR） imaging.
Conclusion
We should not only pay attention to the variation of the neck vessels, but also to the serious secondary changes of intracranial vessels caused by neck vessels variation. Low carotid bifurcation may cause chronic progressive stenosis /occlusion of the proximal MCA or severe ischemic stroke events .
Background
Knowledge about anatomical variants of the external carotid artery is crucial in head and neck surgery and interventional technique. This work aimed to present the frequency of regular and another variant of the external carotid artery using 128 multidetector computed tomography (MDCT) angiography.
Materials and methods
This retrospective study included 120 patients in our university hospital between April 2017 and October 2021. They were 65 men and 55 women (mean age, 45.6 years; range, 18-65 years). They were angiofibroma (10 patients), cerebral stroke (28 patients), partial glossectomy (13 patients), submandibular gland excision (12 patients), parotidectomy (17 patients), mandibulectomy (5 patients), and a thyroidectomy (35 patients). We retrospectively analyzed the level and branches of external carotid arteries on both sides of 120 patients.
Results
According to the level of bifurcation; the external carotid artery originated at the level of the upper border of the thyroid cartilage in 164/240 cases (68.3%), and a higher level was detected in 76/ 240 cases (31.7%). The lower level of origin of the external carotid artery was not detected. The superior thyroid, facial, and lingual arteries originated from separate branches of external carotid arteries in 173/240 cases (72.1%). At the same time, the facial arteries originated with lingual arteries in a common trunk in 67/240 cases (27.9%).
Conclusion
MDCT angiography is a valuable noninvasive diagnostic tool for evaluating the external carotid artery and its branches.
The aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures. Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test. The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height—0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = − 0.19 cm.) than the left one (x = − 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender. Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system.
Background
The internal maxillary artery and extracranial middle meningeal artery are vitally important. Anatomical studies of the relationship of between them using computed tomography angiography are rare.
Material and methods
This study assessed 75 cases involving 150 sides. And the vascular diameters and lengths of the internal maxillary artery and middle meningeal artery were measured using a GE workstation. The distance between the zygomatic arch midpoint and the internal maxillary artery, the angle between the internal maxillary artery and middle meningeal artery were measured, and the middle meningeal artery branch and internal maxillary artery aneurysm were recorded. The internal maxillary artery course classifications were recorded. All of these parameters were statistically analysed.
Results
Ages ranged from 18 to 72 (average 40.2) years, and there were 30 women (40%, 30/75) and 45 men (60%, 45/75). Internal maxillary artery length from its origin to middle meningeal artery origin was 1.37 ± 0.59 cm. The extracranial middle meningeal artery length was 1.79 ± 0.48 cm. The vessel diameters of internal maxillary artery origin, middle meningeal artery origin, and middle meningeal artery at the skull base were 2.93 ± 0.52 mm, 1.58 ± 0.43 mm, and 1.33 ± 0.43 mm, respectively. Among the 150 sides of internal maxillary artery course type, there were 138 superficial (92%, 138/150) and 12 (8%, 12/150) deep course cases. The angle between the internal maxillary artery and middle meningeal artery was 116.2 ± 35.76°.
Conclusions
The findings of this study elucidate the imaging features of the internal maxillary artery and extracranial middle meningeal artery and their relationships, which are helpful for the extracranial–intracranial bypass and endovascular treatment via the internal maxillary artery and middle meningeal artery.
