Surgical Results of Carotid Endarterectomy for Twisted Carotid Bifurcation.

Research paper by Joji J Tokugawa, Kentaro K Kudo, Takashi T Mitsuhashi, Naotake N Yanagisawa, Shuko S Nojiri, Makoto M Hishii

Indexed on: 23 Feb '19Published on: 23 Feb '19Published in: World Neurosurgery


The internal carotid artery (ICA) is normally positioned posterolateral to the external carotid artery (ECA) at the carotid bifurcation. An anatomical variation with the ICA positioned medial to the ECA, the so-called twisted carotid bifurcation, is sometimes encountered in patients undergoing carotid endarterectomy (CEA). Little is known about the twisted carotid bifurcation or the implications for CEA. The present study investigated the demographics and surgical results of our patients with twisted carotid bifurcation who underwent CEA and demonstrates the surgery in a video clip. Eleven of our series of 73 consecutive CEA patients (15.1%) had a twisted carotid bifurcation (TCB group). The basic surgical method was the same for both the TCB and non-TCB groups. The patient demographics were almost identical between the two groups. No significant difference was observed in the degree of stenosis, the duration of operation, or the surgery-related complications between the two groups. However, nine of 11 cases were right-sided in the TCB group; the only significant difference between the groups. CEA for TCB can be safely performed by extension of the normal procedure but with more meticulous preoperative assessment and gentle maneuvers. The reason for the right-side dominance is still unknown. Further investigation is needed of this anatomical entity. Copyright © 2019 Elsevier Inc. All rights reserved.