Bifurcation of Common Carotid Artery in Relation to Vertebral Level in Nepalese: A Cadaveric Study

Abstract

The principal arterial supply of the head and neck are the two Common Carotid Arteries (CCA), they ascend in the neck and each divides into two branches, the External Carotid Artery (ECA) supplying the exterior of the head, neck and the Internal Carotid Artery (ICA) supplying the cranial and orbital cavities. Atherosclerosis of the carotid arteries is a major cause of stroke and transient ischemic attack and it increases with age. The present study was observational based descriptive type, conducted to identify the CCA bifurcation in relation to cervical vertebral level. A total number of 18 cadavers (16 males and 2 females), right and left side of cadavers were studied by dissection method in the Department of Anatomy, NMCTH from February 2020 to February 2021. The ethical approval was taken from NMC- IRC (Ref no- 026-076/077). In present study the frequency of CCA bifurcation in sixteen male Nepalese cadavers (32 samples) on the right and left side was observed and found high level of bifurcation on 31.25% and 37.5% respectively and normal/ standard on the right and left on 68.75% and 62.5% and there were no findings of low bifurcation of CCA. In two female cadavers (4 observations) the level of bifurcation was same on both the side at the level of C3-C4. The Carotid artery injury is possible in different neurological and head and neck surgery. Therefore, the knowledge of variation in level of bifurcation of CCA in different population will be referential to reduce the iatrogenic injury.

Morphometric Study and Branching Patterns of External Carotid Artery Using Computed Tomography Angiography Among the South Indian Population: A Retrospective Study

“…In contrary previous studies showed that there is no bifurcation of CCA at the normal levels, and the most common level was observed at the C4 level, followed by C3 levels [25]. Similarly, many cadaveric studies were done, and their normal level of bifurcation was observed by various authors: 75% [26], 63.15 [27], 48.3% [28], 56.76% [29], 57.5% [30], 22.5% [31], 39% [32], 57% [33], 32.14% [34], 77% [35], 68.72% [36], and 83.75% [37]. In addition, the high and low level of bifurcation was also noted.…”

“…In the present study, high-level and low-level bifurcation is noted in 36% and 56% of CT images, respectively. Similarly, many studies were done in cadaver and CT images, 24.75% [26], 48.3, 5% [28], 63.8%, 13.75% [31], 42%, 1% [33], 8%, 5% [35], 37.5% [36], and 46.5%, 42.3% [38].…”

Is low carotid bifurcation determined by vertebral level always convenient for surgical approach?

“…In addition, the lowest AM in our study was at C4, which was lower than those found in previous studies and could result in the CB becoming much more difficult to access in HCB cases. Most prior studies regarded HCB as CB located above the vertebral body of C3 [ 2 , 13 – 15 ]. Based on this description, we discovered that the occurrence of HCB was as high as 10.47%, which is comparable to prior research employing the same method (CTA) in living Thai people [ 2 ], but with a lower percentage than the 19.2% observed in a Japanese cadaveric study [ 24 ].…”

“…Traditionally, the C3 vertebra has been employed as the gold standard landmark to differentiate between "high" and "low" carotid bifurcations [ 2 , 13 – 15 ]. However, our data draws attention to the possible inadequacies of relying solely on the C3 as a consistent landmark.…”

“…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.…”