Kamide Tomoya, Nomura Motohiro, Tamase Akira, Mori Kentaro, Seki Shunsuke, Kitamura Yoshihisa, Nakada Mitsutoshi
Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, 247-8581, Japan.
Acta Neurochir (Wien). 2016 Dec;158(12):2393-2397. doi: 10.1007/s00701-016-2948-4. Epub 2016 Sep 10.
The internal carotid artery (ICA) usually runs posterolaterally to the external carotid artery (ECA), but occasionally we encounter the twisted carotid bifurcation, a variant in which the ICA courses medially to the ECA during carotid endarterectomy (CEA). Prediction of this anomaly in the preoperative evaluation is mandatory, although descriptions in the literature are limited. We reviewed the clinical features of patients who underwent CEA and analyzed preoperative cerebral angiography, especially the anteroposterior (AP) view to determine whether it could be a predictive modality.
In 58 consecutive CEA cases, we simply classified them into three groups; type 1 (the ICA runs laterally and the ECA runs medially), type 2 (the ICA and ECA run to overlap each other), and type 3 (the ICA runs medially and the ECA runs laterally), based on the findings of AP view of cerebral angiography. We compared the clinical features and intraoperative findings of these groups.
Of 58 cases, types 1-3 were 24, 30, and four cases, respectively. Twisted carotid bifurcations were recognized in seven cases (12.4 %), including three cases in type 2 and four in type 3, and all twisted cases were found on the right side. Twisted carotids and right-sided lesion were significantly frequent in type 3, but no statistical differences of coexisting diseases were recognized among the three groups. CEAs of twisted carotid bifurcations were performed successfully with correction of the carotid position in three and as it was in four cases.
Twisted carotid bifurcations were observed during operation in 10 % in type 2 and 100 % in type 3. CEA of twisted carotid bifurcations can be performed safely with or without correction of the carotid position. AP view of cerebral angiography could be useful for preoperative evaluation.
颈内动脉（ICA）通常走行于颈外动脉（ECA）的后外侧，但偶尔我们会遇到颈动脉分叉扭曲的情况，这是一种在颈动脉内膜切除术（CEA）期间ICA向ECA内侧走行的变异。尽管文献中的描述有限，但在术前评估中预测这种异常情况是必不可少的。我们回顾了接受CEA治疗的患者的临床特征，并分析了术前脑血管造影，尤其是前后位（AP）视图，以确定它是否可以作为一种预测方式。
在连续的58例CEA病例中，我们根据脑血管造影AP视图的结果将它们简单地分为三组；1型（ICA走行于外侧，ECA走行于内侧），2型（ICA和ECA走行相互重叠），3型（ICA走行于内侧，ECA走行于外侧）。我们比较了这些组的临床特征和术中发现。
58例病例中，1 - 3型分别为24例、30例和4例。7例（12.4%）发现颈动脉分叉扭曲，其中2型3例，3型4例，所有扭曲病例均在右侧。3型中扭曲颈动脉和右侧病变明显更常见，但三组间并存疾病无统计学差异。3例扭曲颈动脉分叉的CEA手术通过纠正颈动脉位置成功进行，4例按原样进行。
2型手术中观察到10%的颈动脉分叉扭曲，3型中为100%。扭曲颈动脉分叉的CEA手术无论是否纠正颈动脉位置都可安全进行。脑血管造影的AP视图对术前评估可能有用。
