Skip to main content

Advertisement

SpringerLink
Log in

Geometric morphometric study of anterior branches of external carotid artery and carotid bifurcation by 3D-CT angiography

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data used in this work are available for verification upon request.

References

  1. Acar M, Salbacak A, Sakarya ME, Zararsiz I, Ulusoy M (2013) The morphometrical analysis of the external carotid artery and its branches with multidetector computerized tomography angiography technique. J Morphol. https://doi.org/10.4067/S0717-95022013000400042

    Article  Google Scholar 

  2. Bijari PB, Wasserman BA, Steinman DA (2014) Carotid bifurcation geometry is an independent predictor of early wall thickening at the carotid bulb. Stroke 45(2):473–478. https://doi.org/10.1161/STROKEAHA.113.003454

    Article  PubMed  Google Scholar 

  3. Cappabianca S, Scuotto A, Iaselli F, Pignatelli di Spinazzola N, Urraro F, Sarti G, Rotondo A (2012) Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches. Surg Radiol Anat 34(5):393–399. https://doi.org/10.1007/s00276-011-0926-3

    Article  PubMed  Google Scholar 

  4. Cui Y, Lv X, Wang F, Kong J, Zhao H, Ye Z, Wen J (2020) Geometry of the carotid artery and its association with pathologic changes in a Chinese population. Front Physiol. https://doi.org/10.3389/fphys.2019.01628

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dalessandri D, Tonni I, Laffranchi L, Migliorati M, Isola G, Visconti L, Paganelli C (2020) 2D vs. 3D radiological methods for dental age determination around 18 Years: a systematic review. Appl Sci 10(9):3094. https://doi.org/10.3390/app10093094

    Article  CAS  Google Scholar 

  6. Delić J, Savković A, Bajtarević A, Isaković E (2010) Variations of ramification of external carotid artery–common trunks of collateral branches. Period Biol 112(1):117–119

    Google Scholar 

  7. Dessie MA (2018) Variations of the origin of superior thyroid artery and its relationship with the external branch of superior laryngeal nerve. PLoS ONE 13(5):e0197075. https://doi.org/10.1371/journal.pone.0197075

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Devadas D, Pillay M, Sukumaran TT (2018) A cadaveric study on variations in branching pattern of external carotid artery. Anat Cell Biol 51(4):225–231. https://doi.org/10.5115/acb.2018.51.4.225

    Article  PubMed  PubMed Central  Google Scholar 

  9. Espalieu P, Cottier M, Relave M, Youvarlakis P, Cuilleret J (1986) Radio-anatomic study of the carotid axis with regard to the implantation of microsurgical vascular anastomoses. Surg Radiol Anat 8(4):257–263. https://doi.org/10.1007/BF02425076

    Article  CAS  PubMed  Google Scholar 

  10. Hayashi N, Hori E, Ohtani Y, Ohtani O, Kuwayama N, Endo S (2005) Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir 45(1):25–30. https://doi.org/10.2176/nmc.45.25

    Article  Google Scholar 

  11. Heltzel S, Jelinek L, Jaynes D (2015) Variation in the caudal branches of the external carotid artery: comparison of sex and side. Arch Med Res. https://doi.org/10.18103/mra.v0i1.21

    Article  Google Scholar 

  12. Herrera-Núñez M, Menchaca-Gutiérrez JL, Pinales-Razo R, Elizondo-Riojas G, Quiroga-Garza A, Fernandez-Rodarte BA, Guzmán-López S (2020) Origin variations of the superior thyroid, lingual, and facial arteries: a computed tomography angiography study. Surg Radiol Anat 42(9):1085–1093. https://doi.org/10.1007/s00276-020-02507-6

    Article  PubMed  Google Scholar 

  13. Ito H, Mataga I, Kageyama I, Kobayashi K (2006) Clinical anatomy in the neck region-the position of external and internal carotid arteries may be reversed. Okajimas Folia Anat Jpn 82(4):157–168. https://doi.org/10.2535/ofaj.82.157

    Article  PubMed  Google Scholar 

  14. Jitpun E, Wattanasen Y, Tirakotai W (2019) Do asians have higher carotid bifurcation? A computed tomographic angiogram study of the common carotid artery bifurcation and external carotid artery branching patterns. Asian J Neurosurg 14(4):1082. https://doi.org/10.4103/ajns.AJNS_162_19

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kamenskiy AV, Pipinos II, Carson JS, MacTaggart JN, Baxter BT (2015) Age and disease-related geometric and structural remodeling of the carotid artery. J Vasc Surg 62(6):1521–1528. https://doi.org/10.1016/j.jvs.2014.10.041

    Article  PubMed  Google Scholar 

  16. Klosek SK, Rungruang T (2008) Topography of carotid bifurcation: considerations for neck examination. Surg Radiol Anat 30(5):383–387. https://doi.org/10.1007/s00276-008-0337-2

    Article  PubMed  Google Scholar 

  17. Kurkcuoglu A, Aytekin C, Oktem H, Pelin C (2015) Morphological variation of carotid artery bifurcation level in digital angiography. Folia Morphol 74(2):206–211. https://doi.org/10.5603/FM.2015.0032

    Article  CAS  Google Scholar 

  18. Lučev N, Bobinac D, Marić I, Drešćik I (2000) Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg 122(4):590–591. https://doi.org/10.1067/mhn.2000.97982

    Article  PubMed  Google Scholar 

  19. Michalinos A, Chatzimarkos M, Arkadopoulos N, Safioleas M, Troupis T (2016) Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int. https://doi.org/10.1155/2016/6907472

    Article  PubMed  PubMed Central  Google Scholar 

  20. Midy D, Mauruc B, Vergnes P, Caliot P (1986) A contribution to the study of the facial artery, its branches and anastomoses; application to the anatomic vascular bases of facial flaps. Surg Radiol Anat 8(2):99–107. https://doi.org/10.1007/BF02421376

    Article  CAS  PubMed  Google Scholar 

  21. Natsis K, Raikos A, Foundos I, Noussios G, Lazaridis N, Njau SN (2011) Superior thyroid artery origin in Caucasian Greeks: a new classification proposal and review of the literature. Clin Anat 24(6):699–705. https://doi.org/10.1002/ca.21181

    Article  PubMed  Google Scholar 

  22. Ozgur Z, Govsa F, Ozgur T (2008) Assessment of origin characteristics of the front branches of the external carotid artery. J Craniofac Surg 19(4):1159–1166. https://doi.org/10.1097/SCS.0b013e3180690252

    Article  PubMed  Google Scholar 

  23. Phan TG, Beare RJ, Jolley D, Das G, Ren M, Wong K, Srikanth V (2012) Carotid artery anatomy and geometry as risk factors for carotid atherosclerotic disease. Stroke 43(6):1596–1601. https://doi.org/10.1161/STROKEAHA.111.645499

    Article  PubMed  Google Scholar 

  24. Rollins N, Ison C, Reyes T, Chia J (2005) Cerebral MR venography in children: comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques. Radiology 235(3):1011–1017. https://doi.org/10.1148/radiol.2353041427

    Article  PubMed  Google Scholar 

  25. Shaik E, Hoffmann K, Dietiker JF (2006) Numerical flow simulations of_blood in arteries. In: 44th AIAA Aerospace Sciences Meeting and Exhibit Reno, Nevada, USA. ISBN 978-1-62410-039-0. https://doi.org/10.2514/6.2006-294

  26. Shintani S, Terakado N, Alcalde RE, Tomizawa K, Nakayama S, Ueyama Y, Matsumura T (1999) An anatomical study of the arteries for intraarterial chemotherapy of head and neck cancer. Int J Clin Oncol 4(6):327–330. https://doi.org/10.1007/s101470050079

    Article  Google Scholar 

  27. Thomas JB, Antiga L, Che SL, Milner JS, Hangan Steinman DA, Spence JD, Steinman DA (2005) Variation in the carotid bifurcation geometry of young versus older adults: implications for geometric risk of atherosclerosis. Stroke 36(11):2450–2456. https://doi.org/10.1161/01.STR.0000185679.62634.0a

    Article  PubMed  Google Scholar 

  28. Vázquez T, Cobiella R, Maranillo E, Valderrama FJ, McHanwell S, Parkin I, Sañudo JR (2009) Anatomical variations of the superior thyroid and superior laryngeal arteries. Head Neck 31(8):1078–1085. https://doi.org/10.1002/hed.21077

    Article  PubMed  Google Scholar 

  29. Yalvac ESD, Balak N, Atalay B, Bademci MS, Kocaaslan C, Oztekin A, Aydin E (2019) A new method for determining the level of the carotid artery bifurcation. J Craniofac Surg 30(6):e523–e527. https://doi.org/10.1097/SCS.0000000000005449

    Article  Google Scholar 

  30. Yung CN, De Witt KJ, Keith TG Jr (1990) Three-dimensional steady flow through a bifurcation. J Biomech Eng 112(2):189–197. https://doi.org/10.1115/1.2891171

    Article  CAS  PubMed  Google Scholar 

  31. Zümre Ö, Salbacak A, Çiçekcibaşi AE, Tuncer I, Seker M (2005) Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann Anat 187(4):361–369. https://doi.org/10.1016/j.aanat.2005.03.007

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Special thanks to Human Anatomy Department, Faculty of Medicine, İstinye University. Many thanks to Department of Radiology, School of Medicine, Istinye University Liv Hospital.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Anatomy, School of Medicine, Istinye University, Maltepe Mah., Teyyareci Sami Sk., No.3 Zeytinburnu, 34010, Istanbul, Turkey

    İsmet Demirtaş, Behçet Ayyıldız, Ahmet Taha Demirbaş, Sevilay Ayyıldız, Koral Cağlar Kuş & Mustafa Ayberk Kurt

  2. Graduate School of Health Sciences, İstanbul Medipol University, Istanbul, Turkey

    Ahmet Taha Demirbaş

  3. Department of Radiology, School of Medicine, Istinye University Liv Hospital, Istanbul, Turkey

    Feyza Sönmez Topcu

Authors
  1. İsmet Demirtaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Behçet Ayyıldız
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ahmet Taha Demirbaş
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sevilay Ayyıldız
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Feyza Sönmez Topcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koral Cağlar Kuş
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mustafa Ayberk Kurt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

İD: conceptualization, project development, data analysis, manuscript writing, editing, and final revision; MAK: project development, manuscript writing, and editing; ATD: project development, manuscript writing, and editing; FST: project development, data analysis, manuscript writing, and editing; KÇK: data collection, management, and manuscript writing; SA: data collection, management, and manuscript writing; BA: data collection, management, and manuscript writing; All authors reviewed the manuscript critically, and have read and approved the final manuscript.

Corresponding author

Correspondence to İsmet Demirtaş.

Ethics declarations

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was previously reviewed and approved by the Istinye University Clinical Research Ethics Committee under the registration number 2/2021.K-13.

Informed consent

As there was no concern with identifying information, the authors ensured that consent was obtained at Istinye University Bahçeşehir Liv Hospital, where the images were obtained.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (JPG 891 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demirtaş, İ., Ayyıldız, B., Demirbaş, A.T. et al. Geometric morphometric study of anterior branches of external carotid artery and carotid bifurcation by 3D-CT angiography. Surg Radiol Anat 44, 1029–1036 (2022). https://doi.org/10.1007/s00276-022-02985-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-022-02985-w

Keywords

Search

Navigation