Bifurcation Of Common Carotid Artery Research Articles

Long-term results of carotid endarterectomy and carotid artery stenting in patients with high bifurcation of common carotid artery: a multiple-center study

To analyze in-hospital and long-term results of eversion carotid endarterectomy (CEE), carotid endarterectomy with patch repair and carotid artery stenting (CAS) in patients with high bifurcation of common carotid artery. A retrospective multiple-center open study included 1983 patients who underwent internal carotid artery (ICA) repair for severe stenosis between 2010 and 2021. Three groups of patients were distinguished depending on revascularization option: group 1 (n=638) - eversion CEE; group 2 (n=351) - CEE with patch repair; group 3 (n=994) - CAS. In-hospital postoperative mortality and incidence of stroke and myocardial infarction were similar. All bleedings (n=39) occurred after CEE. ICA thrombosis was diagnosed in groups 1 and 2 due to intimal detachment after insertion of temporary bypass tube. Incidence of laryngeal paresis, neuropathy of hypoglossal and glossopharyngeal nerves, Horner syndrome, damage to salivary glands was comparable in groups 1 and 2. Long-term mortality was the highest (n=10; 2.8%) after CEE with patch repair due to fatal stroke. In turn, the highest incidence of ICA restenosis and restenosis-induced ischemic stroke was observed after CEE with patch repair and CAS. 1. Classical and eversion CEE in patients with high CCA bifurcation is followed by high in-hospital incidence of damage to cranial nerves and salivary glands, laryngeal paresis, Horner syndrome, bleeding and risk of ICA thrombosis. 2. In patients with high CCA bifurcation, CAS and CEE with patch repair are accompanied by high incidence of ICA restenosis, restenosis-induced stroke and mortality in long-term postoperative period. 3. Eversion CEE demonstrates the lowest rates of all adverse cardiovascular events in long-term follow-up period.

Transient Middle Cerebral Artery Occlusion with an Intraluminal Suture Enables Reproducible Induction of Ischemic Stroke in Mice.

Ischemic stroke is a leading cause of mortality and chronic disability worldwide, underscoring the need for reliable and accurate animal models to study this disease's pathology, molecular mechanisms of injury, and treatment approaches. As most clinical strokes occur in regions supplied by the middle cerebral artery (MCA), several experimental models have been developed to simulate an MCA occlusion (MCAO), including transcranial MCAO, micro- or macro-sphere embolism, thromboembolisation, photothrombosis, Endothelin-1 injection, and - the most common method for ischemic stroke induction in murine models - intraluminal MCAO. In the intraluminal MCAO model, the external carotid artery (ECA) is permanently ligated, after which a partially-coated monofilament is inserted and advanced proximally to the common carotid artery (CCA) bifurcation, before being introduced into the internal carotid artery (ICA). The coated tip of the monofilament is then advanced to the origin of the MCA and secured for the duration of occlusion. With respect to other MCAO models, this model offers enhanced reproducibility regarding infarct volume and cognitive/functional deficits, and does not require a craniotomy. Here, we provide a detailed protocol for the surgical induction of unilateral transient ischemic stroke in mice, using the intraluminal MCAO model. Graphic abstract: Overview of the intraluminal monofilament method for transient middle cerebral artery occlusion (MCAO) in mouse.

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI).

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high mortality rate as well as an uncontrollable volume of SAH and other intracranial complications such as stroke or intracranial hemorrhage. In this protocol, a standardized SAH mouse model is presented, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies. Briefly, C57BL/6J mice are anesthetized with an intraperitoneal ketamine/xylazine (70 mg/16 mg/kg body weight) injection and placed in a supine position. After midline neck incision, the common carotid artery (CCA) and carotid bifurcation are exposed, and a 5-0 non-absorbable monofilament polypropylene suture is inserted in a retrograde fashion into the external carotid artery (ECA) and advanced into the common carotid artery. Then, the filament is invaginated into the internal carotid artery (ICA) and pushed forward to perforate the anterior cerebral artery (ACA). After recovery from surgery, mice undergo a 7.0 T MRI 24 h later. The volume of bleeding can be quantified and graded via postoperative MRI, enabling a robust experimental SAH group with the option to perform further subgroup analyses based on blood quantity.

A study of level of common carotid artery bifurcation in relation to the vertebral body level in a cohort of patients referred to the angiography section of Neuro Trauma Centre, National Hospital of Sri Lanka

Background and Objective The carotid bifurcation (CB) is an important anatomical landmark and it is essential to have a thorough knowledge regarding the levels at which it bifurcates occurs in relation to the vertebral body level, especially in the fields of interventional radiology and surgery. Methodology Lateral projection of common carotid run with bony overlay was used to evaluate the level of CB in relation to 13 pre-determined levels. Images of 287 patients; 129 males and 158 females, from 6 to 88 years, who underwent digital subtraction cerebral angiography at a single center in Sri Lanka were included in study. Results Highest CB level was observed at right C2 in both males (n=1, 0.2%) and females (n=15, 2.7%). The lowest in males was seen at left C6/7 (n=1, 0.2%) and in females at C5/6 (n=1, 0.2%). C3 was the commonest CB level (n=174, 23.5%). CB level was found to be significantly lower in males (U=30109.5, p<0.001) and lower on left side (U= 33850.5, p = 0.014). Bilaterally symmetric CBs were seen in 136 (50.9%), which was commoner among females (M:F of 1:1.3) and occurred most frequently at C3 (n = 49, 18.4%). Average mid-cervical internal carotid artery (ICA) diameter was 4.1mm ± 0.9mm and 4.0mm ± 0.8mm and length was between 3.5cm - 12.0cm and 2.9mm to - 10.9mm in males and females respectively. No correlation was found between neck length and the level of CB (p = 0.099). Conclusion The CB level ranging from the highest at C2 to the lowest at C6/7 with the most frequent level of bifurcation being at C3 corresponds to the other available international studies. Similarly, the prevalence of symmetric CBs was also comparable. Mean ICA diameter in our study was lower compared to other studies and may prove to be a useful predictor in local clinical practice.

Bifurcation of Common Carotid Artery in Relation to Vertebral Level in Nepalese: A Cadaveric Study

The principal arterial supply of the head and neck are the two Common Carotid Arteries (CCA), they ascend in the neck and each divides into two branches, the External Carotid Artery (ECA) supplying the exterior of the head, neck and the Internal Carotid Artery (ICA) supplying the cranial and orbital cavities. Atherosclerosis of the carotid arteries is a major cause of stroke and transient ischemic attack and it increases with age. The present study was observational based descriptive type, conducted to identify the CCA bifurcation in relation to cervical vertebral level. A total number of 18 cadavers (16 males and 2 females), right and left side of cadavers were studied by dissection method in the Department of Anatomy, NMCTH from February 2020 to February 2021. The ethical approval was taken from NMC- IRC (Ref no- 026-076/077). In present study the frequency of CCA bifurcation in sixteen male Nepalese cadavers (32 samples) on the right and left side was observed and found high level of bifurcation on 31.25% and 37.5% respectively and normal/ standard on the right and left on 68.75% and 62.5% and there were no findings of low bifurcation of CCA. In two female cadavers (4 observations) the level of bifurcation was same on both the side at the level of C3-C4. The Carotid artery injury is possible in different neurological and head and neck surgery. Therefore, the knowledge of variation in level of bifurcation of CCA in different population will be referential to reduce the iatrogenic injury.

Blunt Cerebrovascular Injury with Severe Head Injury

Blunt Cerebrovascular Injury (BCVI) are rare and comprises of less than 1% of total head injury in our tertiary neurocenter. This leads to significant morbidity and mortality of patient. This case report is to focus on the BCVI with head injury. Because of rarity of this disease, there’s no treatment guidelines. However whatever the treatment we have is based on the experience of the surgeons/physician our case came to our Emergency Room with alleged history of lying along the road side in pool of blood .He was evaluated in peripheral hospital and he was later transferred to our center. Patient on evaluation was found to have transaction of Right ICA just distal to right Common carotid artery bifurcation. There was associated fracture of spinous process C5, C6. Probable mechanism of injury was sudden hyperextension of neck. Patient presented with delayed stroke following BCVI. He was managed with Right Decompressive hemicraniectomy and anticoagulation therapy was started for Right ICA injury. Thus early diagnosis and treatment of Blunt Cerebrovascular injury is essential in traumatic brain injury patients with risk factors for BCVI for definitive treatment of vascular injury with either stenting or surgery and thereby limiting morbidity and mortality of the patient.

Eversion carotid endarterectomy with nerve-sparing component in a case of high location of common carotid artery bifurcation

We performed carotid endarterectomy on a patient with 75% stenosis of the left internal carotid artery (ICA), 70% stenosis of the left common carotid artery (CCA), 60% stenosis of the right ICA and 55% stenosis of the right CCA after a transient ischaemic attack on the premises of the surgical unit of Russian Railways Hospital–Medicine (Samara), which is the clinical site for the care of surgical diseases at Samara State Medical University. During the preoperative evaluation and physical examination, we determined that the chance of high CCA bifurcation was high because the patient had a brachymorphic physique and his neck was short and broad. In fact, during the surgical exploration of the carotid triangle area, the CCA bifurcation was identified 7 ± 0.5 cm higher than the shield-like cartilage rim; thus the CCA bifurcation area crossed the stems of the glossopharyngeal (IX), vagus (X) and hypoglossal (XII) nerves, which precluded classic carotid endarterectomy. We then decided to perform carotid endarterectomy, using the eversion method and transposing the ICA above the rami of the cranial nerves. Through this method, we minimised traction and nerve stem trauma during the process of reconstructing brachiocephalic trunk arteries, prevented morbidities involving the cranial nerves during postsurgical period, accelerated the patient’s recovery and improved the patient’s quality of life. With further patient monitoring during the early and late postoperative periods, no abnormalities of peripheral innervation occurred.Received 26 March 2021. Revised 6 May 2021. Accepted 11 May 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors: The authors contributed equally to this article.

Scour the Unthinkable - Intrathoracic Bifurcation of the Common Carotid Artery With Hypoplastic Internal Carotid Artery.

Scour the Unthinkable - Intrathoracic Bifurcation of the Common Carotid Artery With Hypoplastic Internal Carotid Artery.

Incidental identification of the aberrant origin of left vertebral artery using magnetic resonance angiography: A case report

Background: The vertebral arteries originate from the root of the neck as the first branches of the subclavian arteries. Variations of vertebral arteries are congenital anomalies occurring during embryonic development. Anatomic variations of the left vertebral artery are clinically symptomless and recognized incidentally during angiographic assessments or imaging techniques so the diagnosis of these anomalies is a serious challenge. Anomalous origin of vertebral arteries may lead to neurologic disorders. It is, thus, important to identify variations of the large vessels of the aortic arch when planning neck and cervical spine interventions and diagnostic radiology. For this reason, we would like to present this rare case of left vertebral artery showing a different origin. Case report: In this work, we describe a 60-year-old female patient with headache, lethargy and blurred vision. We employed magnetic resonance angiography for both the brain and neck. There was no lesion in the brain. Incidentally, we found that the root of the left vertebral artery was anatomically aberrant. The left vertebral artery arose from the nearest section of the left external carotid artery, next to the bifurcation of the left common carotid artery, which is a rare variation. Conclusion: Understanding the state of anomalous variations of the origin of the vertebral artery might have crucial implications in angiographic and surgical procedures. It is beneficial to perform more screening with noninvasive studies like neck magnetic resonance angiography in clinical cases with potential symptoms coexisting with other diseases in order to predict possible future problems in intracranial and extracranial interventions. Keywords: Vertebral artery; external carotid artery; anatomic variation; magnetic resonance angiography.

The organization or personified treatment of diseases of coronary arteries considering analysis of bifurcation modifications

The characteristics of development of vascular lines are important for development and improvement of of surgical treatment, decreasing risk of complications and development of personalized approach to treatment of patients. The purpose of the study is to reveal prevalence of different variants of development of common carotid artery bifurcation and to assess their significance for clinical medicine. The sample included 70 volunteers of average age 43.4 ± 10.7 years. The 3D reconstructions of MRI data 1.5 T Brivo 355 were evaluated. The observation data was grouped and processed using software Microsoft Excel 2007 and IBM SPSS Statistics 20. To summarize the data, 5 main variants of location of great vessels were identified. The most rare types of development and course of carotid arteries in bifurcation area were variants "II" and "III" (8.2% of all observations). The most common development options were "I" (51.4%) and "IV" (31.4%). The variants "I" and "IV" were determined relatively evenly.The variants "II" and "III" were found on the right in 60% and 66.7% correspondingly and "V" option was found on the left in 61.5%. The typical options of location of carotid arteries near the bifurcation (variants "I" and "IV"), 82.8% in total. The cases of ventral position of external carotid artery (variants "II" and "V") were established in 12.9%. The variant III was found in 4.3% of all cases. The distribution of vascular development options depending on the gender of patients was investigated. The study did not reveal significantly pronounced deviations in distribution of variants of vascular development, taking into account the age factor. The mentioned data permits to judge with confidence about necessity of developing personalized treatment of diseases of carotid arteries, considering their anatomical features of development in bifurcation area.

Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

Clinical case of a patient with occlusive thrombosis of the right common carotid artery

The paper presents a case of a patient with floating thrombosis in the right common carotid artery and occlusion of the carotid bifurcation of the right common carotid artery against the background of severe atherosclerosis of the common carotid artery with 70% stenosis. Thrombosis was identified using color duplex ultrasound scanning in an asymptomatic patient. During hospitalization, thrombosis was complicated by a cerebral infarction of the right middle cerebral artery, apparently of embolic origin.

Sonographic Reference Values of Vagus Nerve: A Systematic Review and Meta-analysis.

To establish the first comprehensive and standardized set of vagus nerve (VN) sonographic reference values across all the published studies that can be used to standardize and guide clinical practice and research. This systematic review includes all possible available data from a total of 27 studies and 21 of them were included in the meta-analysis having a total of 864 participants. The overall mean cross-sectional area ranged from 2.29 to 2.76 mm2 for the right VN and from 1.83 to 2.23 mm2 for the left VN with 95% confidence interval. Sonographic reference values of VN at common carotid artery bifurcation, thyroid gland, and cartilage as well as other anatomic landmarks were provided. The mean cross-sectional area of the right VN of 2.53 mm2 and the left one of 2.03 mm2 can be considered as sonographic reference values in healthy adults. This review provides these reference values to be considered in the further sonographic evaluation of VNs.

Induction of CCN1 in Growing Saccular Aneurysms: A Potential Marker Predicting Unstable Lesions.

Growing evidence has suggested that inflammatory responses promote the progression of saccular intracranial aneurysms (IAs). However, a biomarker predicting the progression has yet to be established. This study aimed to identify novel molecules upregulated during the progression using a previously established rat aneurysm model. In this model, aneurysms are induced at the surgically created common carotid artery (CCA) bifurcation. Based on sequential morphological data, the observation periods after the surgical manipulations were defined as the growing phase (on the 10th day) or the stable phase (on the 30th day). Total cell lysates from the CCA with or without an aneurysm lesion were prepared to perform protein array analysis. The protein array analysis revealed that the matricellular protein cellular communication network factor 1 (CCN1) is induced in lesions during the growing phase. Immunohistochemistry corroborated the significant upregulation of CCN1 in the growing phase compared with the stable phase. Simultaneously with the induction of CCN1, significant increases in the number of CD68-positive macrophages, myeloperoxidase-positive cells, and proliferating smooth muscle cells in lesions were observed. Immunohistochemistry of human IA specimens reproduced the induction of CCN1 in some lesions. These findings imply a potential role of CCN1 as a marker predicting the progression of saccular aneurysms.

Three-dimensional ultrasound for carotid vessel wall volume measurement.

Objectives:The intima–media thickness (IMT) of the carotid artery can now be detected on a three-dimensional (3D) plane. The 3D vessel wall volume (VWV) more accurately represents vascular conditions. Through 3D ultrasound, we established a standardized method for carotid VWV measurement.Materials and Methods:A total of thirty patients without stroke or cardiovascular disease who received carotid duplex sonography were retrospectively reviewed. Gray-scale 3D images from the distal common carotid artery (CCA) to internal carotid artery on both sides were acquired using a single-sweep 3D transducer and analyzed offline by using the vascular plaque quantification function of the Philips QLAB software. Then, the 3D IMT(QLAB intima–media thickness [QIMT]), total plaque volume (TPV), and VWV were measured by a neurologist and a technician, and the interobserver variability was assessed.Results:The mean two-dimensional (2D) carotid IMT was 0.65 ± 0.12 mm. The mean QIMT, TPV, and VWV measured by observer 1 were 0.68 ± 0.18 mm, 26 ± 12 mm3, and 94 ± 10 mm3, respectively. The Bland–Altman plot of the mean differences between the QIMT, TPV, and VWV values measured by observers 1 and 2 showed that those of observer 2 were within two standard deviations of those of observer 1. Intraclass correlation coefficients (ICCs) indicated strong correlations in QIMT (ICC = 0.76), TPV (ICC = 0.85), and VWV (ICC = 0.90; P < 0.001) between observers 1 and 2. Both 2D IMT and 3D QIMT exhibited a positive linear correlation with age.Conclusion:This study established a standardized VWV measurement through 3D ultrasound. Reasonable interobserver differences were obtained within a 95% limit of agreement and high reliability (ICC = 0.90). The VWV 1 cm from the CCA bifurcation was quantified with a mean value of 94.2 mm3. Further studies on the 3D ultrasound quantification of carotid arteries are warranted.

Variations in Surgical Anatomy of Common Carotid Artery: A Cadaveric Study

Introduction: Carotid arterial system constitutes the principal blood supply of head, neck and brain. In various physiological mechanisms and pathological processes, carotid bifurcation is an important site both anatomically and surgically. Selection of surgical techniques between carotid stenting and carotid endarterectomy requires prior knowledge of level of carotid bifurcation. Aim: To observe the origin, level of bifurcation and geometric measurements of common carotid artery and its variations. Materials and Methods: An observational cross-sectional study was done on 60 formalin embalmed human adult cadavers, of which 47 were male and 13 were female aged between 35-75 years, which were allotted for dissection for first year Bachelor of Medicine and Bachelor of Surgery (MBBS) students in the Department of Anatomy, Government Siddhartha Medical College, Vijayawada, NRI Medical College, Chinakakani and Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinoutapalli, India, during the academic years December 2013 to March 2018. Observations from both right and left common carotid arteries (total 120 sides) were noted. The data observed was tabulated. Statistics in terms of simple percentages were used. The mean arterial diameter±standard deviation of both right and left common carotid arteries were calculated using the Microsoft office excel sheet. Results: In the present study, total of 120 sides of 60 origin of right common carotid artery was found normal and the origin of left common carotid artery from brachiocephalic trunk was found in 5%. Normal level of bifurcation of common carotid artery was found in 82 (68.33%) sides, high level in 26 (21.66%) sides and low level in 12 (10%) sides. The mean arterial diameter±standard deviation of lumen at the origin of right common carotid artery was 0.887±0.132 cm and left common carotid artery was 0.906±0.128 cm and for both right and left common carotid arteries was 0.896±0.129 cm. Conclusion: Detailed study of surgical anatomy of common carotid artery is important for many surgical, radiological and clinical applications. Knowledge of its variations will help to make alterations in surgical interventions and radiological procedures.

Minimally invasive carotid artery surgery

To determine the criteria for choosing a surgical approach and compare an effectiveness of carotid endarterectomy (CEAE) via 3 approaches. The study included 120 patients who underwent CEAE via 3 different approaches. Intraoperative skin marking included lower jaw angle, skin fold closest to common carotid artery bifurcation. Carotid artery bifurcation and borders of atherosclerotic plaque were visualized using ultrasound. An effectiveness of each access was evaluated in accordance with the following criteria: neurological complications, cosmetic effect and quality of life after 1 and 12 months. The patients were divided into 2 groups. Group I - 80 patients with CEAE with access through the natural skin fold (NSF); group II - 40 patients with CEAE using the classical longitudinal access. The 1st group was divided into 2 subgroups. Subgroup I A - 39 patients with CEAE using mini-access via NSF; subgroup I B - 41 patients with CEAE using extended access via NSF. There were no strokes and transient ischemic attacks in a month after surgery in both groups. After 12 months, stroke occurred in 2 (%) patients of group II, cranial neuropathy - 8 (21%) patients in the same group. The best cosmic effect was achieved in subgroup I A after 1 and 12 months (37.1±6.7 scores). Mean score of physical health was 51.59±5.9 scores in subgroup I A, 46.03±7.53 scores - in subgroup I B, 38.84±5.28 scores - in group II. Index of mental health was 49.63±6.69, 45.68±5.6, and 48.59±7.29 scores, respectively. Considering these data, we developed a personalized computer program ensuring fast choice of optimal surgical approach.

Predictive value of carotid artery ultrasonography for the risk of coronary artery disease.

To assess carotid intima-media thickness (IMT), carotid plaques, and cardiovascular risk factors in patients with suspected coronary artery disease (CHD) to determine their association and predictive value for CHD. We performed duplex Doppler ultrasonography of the carotid arteries and coronary angiography or CT in 480 patients with suspected CHD, and investigated their personal and medical histories. Patients were then assigned to the CHD or the control group depending on the presence of coronary lesions. Ultrasonography was performed the morning after admission prior to any treatment, coronary angiography, or CT. Carotid plaques were mainly distributed in the common carotid artery bifurcation, with a significant difference between the CHD and control groups. Plaque incidence (80%) and IMT were significantly higher (P < .001 and P = .012, respectively) in the CHD (80% and 0.84 ± 0.21 mm) than in the control group (49% and 0.76 ± 0.18 mm). The factors significantly associated with CHD were introduced into a multivariate regression model. Male subject (OR = 1.569, 95%CI 1.004-2.453; P = .048) and plaque burden (OR = 0.457, 95%CI 0.210-0.993; P = .048) were significant predictors for CHD occurrence. The presence of carotid plaques performed significantly better than IMT and the Framingham risk score for predicting CHD lesions (P < .001 for both). CHD patients showed higher percentage of clinical (plaques) or subclinical (IMT) carotid artery wall change, and the presence of carotid plaques showed better predictive value than IMT and Framingham risk score for the presence of coronary artery lesions.

VARIATION IN ORIGIN OF SUPERIOR THYROID ARTERY AND ITS CLINICAL RELEVANCE: A CASE REPORT

Thyroid surgeries are most common neck surgeries; hence thorough knowledge of the variations in blood supply of this gland to the surgeons is very important to prevent any alarming hemorrhage or iatrogenic damage. We found a variation in origin of superior thyroid artery on right side during routine dissection on an adult male cadaver in the Department of Anatomy, A.I.I.M.S, NewDelhi. Left superior thyroid artery was normal. Right side, superior thyroid artery was arising from common carotid artery instead of external carotid artery, just proximal to the bifurcation of common carotid artery. This variant branching pattern of superior thyroid artery is very rare. The inferior thyroid arteries did not show any unusual origin. Knowledge of such arterial variations related to the thyroid gland is immensely helpful to the surgeons to avoid damage of the vital organs in this region.

Pulmonary hypertension in patients with hemodynamically significant atherosclerotic lesion of a common carotid artery: new pathophysiological mechanisms of the disease

Background. Pulmonary hypertension (PH) is a severe pathology that often leads a patient to death or disability. Recently, the development of PH associated with activation of the sympathetic nervous system (SNS) has been of interest. Some results obtained in an acute experiment on rats showed that activation of the carotid bodies of one external carotid artery is a sufficient stimulus to increase the tone of pulmonary arteries. Obviously, this effect is mediated by the sympathetic nervous system. However, the long-term effects of unilateral hypoxia of the carotid bodies on the morphofunctional state of the pulmonary arteries are not described in the literature.&#x0D; Aim. Effect assessment of common carotid artery bifurcation region ischemia due to the atherosclerotic process on the pulmonary arteries in patients.&#x0D; Materials and methods. The retrospective study was conducted in the Burdenko Neurosurgical Center and in the National Medical Research Center for Cardiology. A total of 60 case histories were analyzed in detail. All patients underwent Duplex scanning of the brachiocephalic arteries, as well as transthoracic echocardiography. The study included patients with atherosclerotic plaque in the area of the common carotid artery bifurcation on either one side or both. Exclusion criteria consisted of diseases that lead to the development of PH. The relationship between the presence of hemodynamically significant atheroma and the development of PH was evaluated.&#x0D; Results. Patients were divided into two groups those with hemodynamically significant atherosclerotic plaque in the common carotid artery bifurcation region at least on one side (more than 75% of the vascular obstruction) and hemodynamically insignificant atheromas in the common carotid artery bifurcation region on one or both sides (less than 45%). Among patients from the first group, 52.8% of the patients had signs of PH. Among patients from the second group, only 16.7% of the patients had signs of PH. The difference in the frequency of PH occurrence between the two selected groups is statistically significant (p=0.005). There were no differences in red blood cells number, platelets number, glucose concentration and lipid composition of blood plasma.&#x0D; Conclusion. Activation of SNS due to hemodynamically significant atherosclerotic plaque in the area of the bifurcation of the common carotid artery may be an independent mechanism for the development of PH.&#x0D; Key words: pulmonary hypertension, carotid bodies, atherosclerotic plaque, sympathectomy of pulmonary arteries.