Surgical Anatomy of the Cervical Carotid Artery for Carotid Endarterectomy

Abstract

Carotid endarterectomy (CEA) is the main treatment for atherosclerotic plaque of the cervical internal carotid artery. The surgical anatomy of the carotid arteries was studied in the carotid triangle of 49 cadavers. The carotid bifurcation was located at the level of the lower third of C-3. The superior thyroid artery arose from the anterior wall of the external carotid artery in 70% of specimens and from the distal portion of the common carotid artery in 30%. The lingual artery arose as a separate trunk between the origins of the superior thyroid and facial arteries in 81% of specimens, with the facial artery from a common trunk in 18%, and with the superior thyroid artery in 1%. The occipital artery arose from the posterior aspect of the external carotid artery above the level of origin of the facial artery in 57% of specimens, between the origins of the facial and lingual arteries in 32%, and below the origin of the lingual artery in 11%. The origin of the occipital artery was positioned low and the distal portion of the occipital artery was crossed by the hypoglossal nerve in 20%. The ascending pharyngeal artery arose from the posterior wall of the external carotid artery above the level of origin of the lingual artery in 66% of specimens, below the origin of the lingual artery in 9%, from the proximal portion of the occipital artery in 19%, from the carotid bifurcation in 2%, and from the internal carotid artery in 2%. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries. It is necessary to understand the surgical anatomy of the carotid arteries to carry out successful removal of plaque and minimize postoperative complications in a bloodless surgical field.

Anatomical Variations of the Common Carotid Artery Bifurcations in Relation to the Cervical Vertebrae in Ethiopia

“…The level of bifurcation according to the research done in Kenya on 40 cadavers was symmetrical in all cases [7], and another study done in Japan, Tokyo, on 49 cadavers found no difference in level between the two sides in all cases [13].…”

“…A high common carotid artery bifurcation possesses a higher risk of being hit by intra articular screws during procedures on cervical the vertebrae [7][8][9][10][11][12][13][14][15]. Thus, knowledge on the anatomical variations of the carotid bifurcation (CB) is necessary for the correct interpretation of results obtained by means of different radiological procedures and for vascular surgical procedures in the region mainly because of the significant rates of the occurrence of variations.…”

Carotid Artery Stenting for Atherosclerotic Stenosis Associated With Non-bifurcating Cervical Carotid Artery

“…It is well known that the occipital artery can arise from the ICA, and the ascending pharyngeal artery arose from the ICA in a few cases. 1,4) Consequently, segment 1 could further be divided into 2 or 3 parts by the branching points of the proatlantal or hypoglossal artery. Therefore, speculation would suggest that non-bifurcating cervical carotid artery is formed by agenesis of the proximal part of segment 1 using the pharyngo-occipital artery system as a collateral pathway (Table 1, Fig.…”

Bilateral Variation in the Carotid Arterial System: A Case Report

“…These variations are important for plastic surgeons to get a bloodless field and to avoid iatrogenic injuries during the reconstructive surgeries of head & neck region and also in cervical lymphadenectomy [2,3].It is of significance to the radiologists in the interpretation of angiograms of head and neck region.The knowledge of the branching pattern of external carotid artery forms the basis for the proper placement of cross clamps on the carotid artery [4] …”