REVIEW PAPER
Clinical implications of variations of common carotid artery trifurcation
1
Human Anatomy Research Group, Medical University, Lublin, Poland
2
1st Military Clinical Hospital with Outpatient Clinic, Lublin, Poland
3
Department of Normal, Clinical, and Imaging Anatomy, Lublin, Poland
Corresponding author
Serhii Homzar
Serhii Homzar, Human Anatomy Research Group, Medical University, Jaczewskiego 4, 20-090 Lublin, Poland
Serhii Homzar, Human Anatomy Research Group, Medical University, Jaczewskiego 4, 20-090 Lublin, Poland
J Pre Clin Clin Res. 2024;18(1):83-87
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Common carotid arteries are paired vessels supplying the head and neck, and in surgical practice their trifurcation can impact the effectiveness of various oncologic, reconstructive, and interventional procedures. Understanding anatomical variations is crucial for avoiding complications and improving procedural safety. The aim of the study was to review the literature and systematize knowledge regarding the anatomy of the common carotid a. trifurcation, with particular emphasis on its role in procedures such as carotid a. stenting, carotid endarterectomy, tumour embolization, glossectomy, thyroidectomy, and lymph node resection.
Review methods:
A literature review (including 9 original studies and 11 case reports) was conducted, considering studies on the anatomy of the common carotid a. trifurcation based on cadaveric and radiological material. Various variants of the common carotid a. trifurcation were identified, and their frequency of occurrence documented in the study.
Brief description of the state of knowledge:
Based on the analyzed literature, the most frequently observed third branch of the division was the superior thyroid a. (20–76.6%). Other isolated cases included the superior laryngeal a., ascending pharyngeal a., occipital a., and lingual a.
Conclusions:
Analyzing the diversity of the common carotid a. trifurcation reveals its frequent occurrence, suggesting the necessity to consider this variability in head and neck medical procedures. The most common third branch is the superior thyroid a., which holds significant importance for diagnostic and therapeutic strategies in the area of the thyroid gland. While cases of large vessels, such as the vertebral a., departing from the trifurcation are rare, their consideration is crucial in procedural planning.
Common carotid arteries are paired vessels supplying the head and neck, and in surgical practice their trifurcation can impact the effectiveness of various oncologic, reconstructive, and interventional procedures. Understanding anatomical variations is crucial for avoiding complications and improving procedural safety. The aim of the study was to review the literature and systematize knowledge regarding the anatomy of the common carotid a. trifurcation, with particular emphasis on its role in procedures such as carotid a. stenting, carotid endarterectomy, tumour embolization, glossectomy, thyroidectomy, and lymph node resection.
Review methods:
A literature review (including 9 original studies and 11 case reports) was conducted, considering studies on the anatomy of the common carotid a. trifurcation based on cadaveric and radiological material. Various variants of the common carotid a. trifurcation were identified, and their frequency of occurrence documented in the study.
Brief description of the state of knowledge:
Based on the analyzed literature, the most frequently observed third branch of the division was the superior thyroid a. (20–76.6%). Other isolated cases included the superior laryngeal a., ascending pharyngeal a., occipital a., and lingual a.
Conclusions:
Analyzing the diversity of the common carotid a. trifurcation reveals its frequent occurrence, suggesting the necessity to consider this variability in head and neck medical procedures. The most common third branch is the superior thyroid a., which holds significant importance for diagnostic and therapeutic strategies in the area of the thyroid gland. While cases of large vessels, such as the vertebral a., departing from the trifurcation are rare, their consideration is crucial in procedural planning.
Biskupski M, Homzar S, Dąbrowska Z, Buczek J, Daniluk A, Iwaniuk, Białkowska Z, Stachowicz H, Samczuk M, Ostański J. Clinical implications
of variations of common carotid artery trifurcation. J Pre-Clin Clin Res. 2024; 18(1): 83–87. doi: 10.26444/jpccr/186029
REFERENCES (45)
1.
Murray A, Meguid EA. Anatomical variation in the branching pattern of the aortic arch: a literature review. Ir J Med Sci. 2023;192(4):1807–1817. https://doi:10.1007/s11845-022....
2.
Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT Clin Radiol. 2010;65(6):481–487. https://doi:10.1016/j.crad.201....
3.
Lo A, Oehley M, Bartlett A, Adams D, Blyth P, Al-Ali S. Anatomical variations of the common carotid artery bifurcation. ANZ J Surg. 2006;76(11):970–972. https://doi:10.1111/j.1445-219....
4.
Klosek SK, Rungruang T. Topography of carotid bifurcation: considerations for neck examination. Surg Radiol Anat. 2008;30(5):383–387. https://doi:10.1007/s00276-008....
5.
Andani R, Khan YS. Anatomy, Head and Neck: Carotid Sinus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 24, 2023.
6.
Arumugam S, Subbiah NK. A Cadaveric Study on the Course of the Cervical Segment of the Internal Carotid Artery and Its Variations. Cureus. 2020;12(4):e7663. Published 2020 Apr 13. https://doi:10.7759/cureus.766....
7.
Teal JS, Rumbaugh CL, Segall HD, Bergeron RT. Anomalous branches of the internal cartoid artery. Radiology. 1973;106(3):567–73. https://doi: 10.1148/106.3.567.
8.
Björck M, Bergqvist D. Intraoperative identification of the internal carotid artery: a safety issue. J Vasc Surg. 2006;43(1):159–161. https://doi:10.1016/j.jvs.2005....
9.
Szczeklik A, Gajewski P. Interna Szczeklika 2021. 12th edition. Kraków: Wydawnictwo Medycyna Praktyczna; 2021. ISBN 978-83-7430-459-7.
10.
Mechtouff L, Rascle L, Crespy V, Canet-Soulas E, Nighoghossian N, Millon A. A narrative review of the pathophysiology of ischemic stroke in carotid plaques: a distinction versus a compromise between hemodynamic and embolic mechanism. Ann Transl Med. 2021;9(14):1208. https://doi:10.21037/atm-20-74....
11.
Yang SS, Woo SY, Kim DI Analysis of atherosclerotic plaque distribution in the carotid artery. Clin Cardiol. 2022;45(12):1272–1276. https://doi:10.1002/clc.23903.
12.
Rahim AA, Thabet MA, Galal AM, Hammoda MI, Mittapalli D. Stroke incidence between stenting and endarterectomy for asymptomatic carotid artery stenosis. Ann Med Surg (Lond). 2022;79:104083. Published 2022 Jun 27. https://doi:10.1016/j.amsu.202....
13.
Morris DR, Ayabe K, Inoue T, et al. Evidence-Based Carotid Interventions for Stroke Prevention: State-of-the-art Review. J Atheroscler Thromb. 2017;24(4):373–387. https://doi:10.5551/jat.38745.
14.
Bounajem MT, Grandhi R, Kilburg CJ, Taussky P. Patient-Tailored Stenting versus Endarterectomy for the Treatment of Asymptomatic Carotid Artery Stenosis. J Pers Med. 2022;12(6):882. Published 2022 May 27. https://doi:10.3390/jpm1206088....
15.
Borges A, Ramalho S, Ferreira L Common carotid artery trifurcation: a potentially dangerous anatomical variant. BMJ Case Rep. 2021;14(2):e241104. Published 2021 Feb 8. https://doi:10.1136/bcr-2020-2....
16.
Ogeng’o JA, Misiani M, Malek A Variant termination of the common carotid artery: cases of quadrifurcation and pentafurcation. Anatomy Journal of Africa. 2014;3:386–92.
17.
Lucev N, Bobinac D, Maric I, Drescik I. Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg.2000;122(4):590–591. https://doi:10.1067/mhn.2000.9....
18.
Marques SR, Itezerote AM, Saviolo Zoreiro Deangelis MA, & Prates JC (2002). Anatomical variations of the occipital artery: Relate of two cases. Rev Chil Anat. 20:193–6.
19.
Cavalcanti DD, Reis CV, Hanel R, et al. The ascending pharyngeal artery and its relevance for neurosurgical and endovascular procedures. Neurosurgery. 2009;65(6 Suppl):114–120. https://doi:10.1227/01.NEU.000....
20.
Natsis K, Raikos A, Foundos I, Noussios G, Lazaridis N, Njau SN Superior thyroid artery origin in Caucasian Greeks: A new classification proposal and review of the literature. Clin Anat. 2011;24(6):699–705. https://doi:10.1002/ca.21181.
21.
Al-Rafiah A, EL-Haggagy AA, Aal IH, Zaki AI Anatomical study of the carotid bifurcation and origin variations of the ascending pharyngeal and superior thyroid arteries. Folia Morphol (Warsz). 2011;70(1):47–55.
22.
Vázquez T, Cobiella R, Maranillo E, et al. Anatomical variations of the superior thyroid and superior laryngeal arteries. Head Neck. 2009;31(8):1078–1085. https://doi:10.1002/hed.21077.
23.
Joshi A, Gupta S, Variya VH 2014. Anatomical variation in the origin of superior thyroid artery and its relation with external laryngeal nerve. Nat J Med Res. 4:138–141.
24.
Gupta P, Bhalla AS, Thulkar S, et al. Variations in superior thyroid artery: A selective angiographic study. Indian J Radiol Imaging. 2014;24(1):66–71. https://doi:10.4103/0971-3026.....
25.
Altinbas NK, Unal S, Peker A, Uzun C, Akkaya Z, Peker E. Trifurcation of the Left Common Carotid Artery. Pol J Radiol. 2015;80:376–378. Published online 2015 Aug 1. https://doi: 10.12659/PJR.894579.
26.
Gürbüz J, Cavdar S, Ozdoğmuş O. Trifurcation of the left common carotid artery: a case report. Clin Anat. 2001;14(1):58–61. https://doi:10.1002/1098-2353(...<58::AID-CA1011>3.0.CO;2-M.
27.
Chitra R Trifurcation of the right common carotid artery. Indian J Plast Surg. 2008;41(1):85–88. https://doi:10.4103/0970-0358.....
28.
Patil PV, Patil AM, Apte AV, Attarde VY. Anomalous Origin of Left Vertebral Artery from Carotid Bulb Seen as “Trifurcation” of Left Common Carotid Artery with Acute Infarct in Ipsilateral Thalamus: A Case Report. J Neuroimaging. 2015;25(4):662–664. https://doi:10.1111/jon.12172.
29.
Shreevastava AK, Das RS, Maheshwari TP, Damodhar BK. Bilateral High Trifurcation of the Common Carotid Artery and Variable Emergence of the Lower Branches of the External Carotid Artery: A Cadaveric Case Report. Cureus. 2022;14(8):e27657. Published 2022 Aug 3. https://doi:10.7759/cureus.276....
30.
Szymańska K, Pozowski P, Misiak P, et al. Trifurcation of the right common carotid artery-Case report. Radiol Case Rep. 2020;15(6):775–779. Published 2020 Apr 15. https://doi:10.1016/j.radcr.20....
31.
Kapre M, Mangalgiri AS, Mahore D. Study of thyro-lingual trunk and its clinical relevance. Indian J Otolaryngol Head Neck Surg. 2013;65(2):102–104. https://doi:10.1007/s12070-011....
32.
Jadhav SD, Ambali MP, Patil RJ, Roy PP Thyrolingual trunk arising from the common carotid bifurcation. Singapore Med J. 2011;52(12):e265-e266.
33.
Borges A, Ramalho S, Ferreira L Common carotid artery trifurcation: a potentially dangerous anatomical variant. BMJ Case Rep. 2021;14(2):e241103. Published 2021 Feb 8. https://doi:10.1136/bcr-2020-2....
34.
Sugavasi R, Sujatha M, Indira DB, Sirisha B, Kanchana L Variant origin of thyrolinguo-facial trunk from left common carotid artery – A case report. Int J Health Sci Res. 2012;2:92–95.
35.
Kishve PS, Kishve SP, Joshi M, Aarif SM, Kalakoti P. An unusual branching pattern of common and external carotid artery in a human cadaver: a case report. Australas Med J. 2011;4(4):180–182. https://doi:10.4066/AMJ.2011.6....
36.
Jargiełło T, Sojka M, Wolski A, Wojczal J, Żywicki W, Luchowski P, Krupiński R, Drelich-Zbroja A, Szczerbo-Trojanowska M. Stenting of Carotid Artery Stenosis – 15 years of Experience from the Lublin Center. Borgis. Postępy Nauk Medycznych. 2012;5:393–401.
37.
Bi Y, Shi X, Zhang W, Lu H, Han X, Ren J. Drug-Eluting Embolics Chemoembolization for the Management of Recurrent or Advanced Head and Neck Cancer. J Vasc Interv Radiol. 2022;33(8):949–955. https://doi:10.1016/j.jvir.202....
38.
Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol. 2006;23(2):126–142.https:// doi:10.1055/s-2006-941443.
40.
Bigcas JLM, Okuyemi OT Glossectomy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 25, 2023.
41.
Zarokosta M, Foutsitzi A, Mpartziotas I, Manthas A, Tsiaoussis J, Mariolis-Sapsakos T. Anomalous anatomic trajectory of the superior thyroid artery encountered during thyroidectomy. A rare case report. J Surg Case Rep. 2021;2021(4):rjab030. Published 2021 Apr 24. https://doi:10.1093/jscr/rjab0....
42.
4Wistermayer P, Anderson KG. Radical Neck Dissection. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 30, 2023.
43.
Onmez A, Gokosmanoglu F, Baycelebi G, Arıkan AA. Carotid Doppler ultrasonographic findings of dapagliflozin use in type 2 diabetic patients. Aging Male. 2020;23(5):1246–1250. https://doi:10.1080/13685538.2....
44.
Stula I, Kojundzic SL, Guic MM, Novak K. Carotid artery stenosis in correlation with neck and carotid artery anatomy. Vascular. 2022;30(3):524–531. https://doi:10.1177/1708538121....
45.
Baz RA, Scheau C, Rusali AC, Bordei P. Computed tomography-assessed variations of the carotid sinus. Surg Radiol Anat. 2022;44(2):293–298. https://doi:10.1007/s00276-021....
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