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Computed tomography-assessed variations of the carotid sinus

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Abstract

Purpose and background

Previous studies have identified variations regarding the morphology and location of the carotid sinus, a phenomenon still not commonly approached or studied on computed tomography angiography (CTA). Detailed characterization of the carotid sinus was performed on CTAs, determining its position, diameter and length.

Methods

The study group included 43 patients with disease-free carotid trunks subjected to cervical CTA. We measured the terminal caliber of the common carotid artery (CCA), as well as the calibers of the internal (ICA) and external carotid arteries (ECA) at their origin. The diameters were correlated with the location and the shape of the carotid sinus. We also measured the length of the sinus dilatation (carotid bulb), in regard to its location on the terminal branches of the common carotid artery.

Results

Mean diameters of the studied arteries were 7.39 ± 1.04 mm for the CCA, 6.71 ± 1.49 mm for the ICA and, respectively, 4.27 ± 0.75 mm for the ECA. The classical position of the carotid sinus was seen in 80% of cases, the rest being considered anatomical variants. The length of the carotid bulb on the ICA was 9.99 ± 2.22 mm, showing variability between genders.

Conclusions

The carotid sinus does not always extend to the ICA, presenting different distribution patterns that might be relevant in sinus pathology from a clinical point of view, respectively from a surgical point of view during invasive or minimally invasive interventions on the carotid axis.

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Availability of data and materials

The data presented in this study are available on reasonable request from the corresponding author.

References

  1. Ameenuddin M, Anand M (2019) CFD analysis of hemodynamics in idealized abdominal aorta-renal artery junction: preliminary study to locate atherosclerotic plaque. Comput Res Model 11:695–706. https://doi.org/10.20537/2076-7633-2019-11-4-695-706

    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 45:473–478. https://doi.org/10.1161/strokeaha.113.003454

    Article  PubMed  Google Scholar 

  3. Bonati LH, Dobson J, Featherstone RL, Ederle J, van der Worp HB, de Borst GJ, Mali WP, Beard JD, Cleveland T, Engelter ST, Lyrer PA, Ford GA, Dorman PJ, Brown MM (2015) Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 385:529–538. https://doi.org/10.1016/s0140-6736(14)61184-3

    Article  PubMed  PubMed Central  Google Scholar 

  4. Choudhry FA, Grantham JT, Rai AT, Hogg JP (2016) Vascular geometry of the extracranial carotid arteries: an analysis of length, diameter, and tortuosity. J Neurointerv Surg 8:536–540. https://doi.org/10.1136/neurintsurg-2015-011671

    Article  PubMed  Google Scholar 

  5. Gallo D, Bijari PB, Morbiducci U, Qiao Y, Xie YJ, Etesami M, Habets D, Lakatta EG, Wasserman BA, Steinman DA (2018) Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: an in vivo human study. J R Soc Interface. https://doi.org/10.1098/rsif.2018.0352

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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 62:1521–1528. https://doi.org/10.1016/j.jvs.2014.10.041

    Article  PubMed  Google Scholar 

  7. Kikuta S, Iwanaga J, Kusukawa J, Tubbs RS (2019) Carotid sinus nerve: a comprehensive review of its anatomy, variations, pathology, and clinical applications. World Neurosurg 127:370–374. https://doi.org/10.1016/j.wneu.2019.04.064

    Article  PubMed  Google Scholar 

  8. Kotsis T, Christoforou P, Nastos K (2020) Carotid body baroreceptor preservation and control of arterial pressure in eversion carotid endarterectomy. Int J Angiol 29:33–38. https://doi.org/10.1055/s-0039-3400478

    Article  PubMed  Google Scholar 

  9. Kwak BR, Bäck M, Bochaton-Piallat ML, Caligiuri G, Daemen MJ, Davies PF, Hoefer IE, Holvoet P, Jo H, Krams R, Lehoux S, Monaco C, Steffens S, Virmani R, Weber C, Wentzel JJ, Evans PC (2014) Biomechanical factors in atherosclerosis: mechanisms and clinical implications. Eur Heart J 35(3013–3020):3020a–3020d. https://doi.org/10.1093/eurheartj/ehu353

    Article  CAS  Google Scholar 

  10. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, Biasi G, Norgren L (2009) ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 37:1–19. https://doi.org/10.1016/j.ejvs.2008.11.006

    Article  CAS  PubMed  Google Scholar 

  11. McGill HC Jr, Strong JP (1968) The geographic pathology of atherosclerosis. Ann N Y Acad Sci 149:923–927. https://doi.org/10.1111/j.1749-6632.1968.tb53846.x

    Article  PubMed  Google Scholar 

  12. Nagargoje M, Gupta R (2020) Effect of sinus size and position on hemodynamics during pulsatile flow in a carotid artery bifurcation. Comput Methods Programs Biomed 192:105440. https://doi.org/10.1016/j.cmpb.2020.105440

    Article  PubMed  Google Scholar 

  13. Paraskevas KI, Robertson V, Saratzis AN, Naylor AR (2018) Editor’s choice - an updated systematic review and meta-analysis of outcomes following eversion vs. conventional carotid endarterectomy in randomised controlled trials and observational studies. Eur J Vasc Endovasc Surg 55:465–473. https://doi.org/10.1016/j.ejvs.2017.12.025

    Article  PubMed  Google Scholar 

  14. Parry SW (2020) Should we ever pace for carotid sinus syndrome? Front Cardiovasc Med 7:44–44. https://doi.org/10.3389/fcvm.2020.00044

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK (2011) Updated society for vascular surgery guidelines for management of extracranial carotid disease. J Vasc Surg 54:e1-31. https://doi.org/10.1016/j.jvs.2011.07.031

    Article  PubMed  Google Scholar 

  16. Roskam J (1930) Un syndrome nouveau, syncopes cardiaques graves et syncopes répétées par hyperréflectivité sino-carotidienne, par Jacques Roskam. Masson

  17. Rouvière H, Delmas A (1997) Anatomie humaine: descriptive, topographique et fonctionnelle vol 1. 14e édition edn. Elsevier Masson, Paris

    Google Scholar 

  18. Saho T, Onishi H (2017) Quantitative analysis of effects of hemodynamic stress on temporal variations of cardiac phases in models of human carotid bulbs. Radiol Phys Technol 10:475–482. https://doi.org/10.1007/s12194-017-0421-6

    Article  PubMed  Google Scholar 

  19. Seong J, Lieber BB, Wakhloo AK (2005) Morphological age-dependent development of the human carotid bifurcation. J Biomech 38:453–465. https://doi.org/10.1016/j.jbiomech.2004.04.022

    Article  PubMed  Google Scholar 

  20. Taurino M, Filippi F, Persiani F, Tirotti C, Dito R, Brancadoro D, Rizzo L (2014) Hemodynamic changes in Chevalier eversion versus conventional carotid endarterectomy. Eur J Vasc Endovasc Surg 48:514–520. https://doi.org/10.1016/j.ejvs.2014.08.005

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Toorop RJ, Scheltinga MR, Moll FL, Bleys RL (2009) Anatomy of the carotid sinus nerve and surgical implications in carotid sinus syndrome. J Vasc Surg 50:177–182. https://doi.org/10.1016/j.jvs.2009.03.029

    Article  PubMed  Google Scholar 

  23. Vavra AK, Eskandari MK (2015) Treatment options for symptomatic carotid stenosis: timing and approach. Surgeon 13:44–51. https://doi.org/10.1016/j.surge.2014.09.001

    Article  PubMed  Google Scholar 

  24. Wells DR, Archie JP, Kleinstreuer C (1996) Effect of carotid artery geometry on the magnitude and distribution of wall shear stress gradients. J Vasc Surg 23:667–678. https://doi.org/10.1016/S0741-5214(96)80048-6

    Article  CAS  PubMed  Google Scholar 

  25. West CT, Brassett C, Gaunt ME (2018) Variations in carotid sinus anatomy and their relevance to carotid interventions. Folia Morphol (Warsz) 77:693–697. https://doi.org/10.5603/FM.a2018.0017

    Article  CAS  Google Scholar 

  26. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501. https://doi.org/10.1056/NEJMoa040127

    Article  CAS  PubMed  Google Scholar 

  27. Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Glagov S (1983) Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res 53:502–514. https://doi.org/10.1161/01.res.53.4.502

    Article  CAS  PubMed  Google Scholar 

  28. Zümre O, Salbacak A, Ciçekcibaşi 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 187:361–369. https://doi.org/10.1016/j.aanat.2005.03.007

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, “Ovidius” University, 900470, Constanta, Romania

    Radu-Andrei Baz

  2. Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474, Bucharest, Romania

    Cristian Scheau

  3. Department of Cardiology, Faculty of Medicine, “Ovidius” University, 900470, Constanta, Romania

    Andrei Constantin Rusali

  4. Department of Anatomy, Faculty of Medicine, “Ovidius” University, 900470, Constanta, Romania

    Petru Bordei

Authors
  1. Radu-Andrei Baz
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  2. Cristian Scheau
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  3. Andrei Constantin Rusali
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  4. Petru Bordei
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Contributions

Conceptualization: R-AB, PB; methodology: R-AB, PB; formal analysis and investigation: R-AB, CS, PB; writing—original draft preparation: R-AB, CS, ACR, PB; writing—review and editing: R-AB, CS; resources: R-AB, ACR; supervision: PB. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cristian Scheau.

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Conflict of interest

None declared.

Ethical approval

Approved by the Ethics Committee of "Sf. Apostol Andrei" County Hospital (no. 34490/8th August 2019).

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Signed informed consent was obtained from all subjects involved in the study.

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Signed informed consent was obtained from all subjects involved in the study.

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Baz, RA., Scheau, C., Rusali, A.C. et al. Computed tomography-assessed variations of the carotid sinus. Surg Radiol Anat 44, 293–298 (2022). https://doi.org/10.1007/s00276-021-02871-x

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  • DOI: https://doi.org/10.1007/s00276-021-02871-x

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