Variations in carotid sinus anatomy and their relevance to carotid interventions

• Autorzy: West C.T. , Brassett C. , Gaunt M.E.
• Języki publikacji: EN

Abstrakty

EN

Background: The carotid sinus (CS) is a dilatation in the carotid bifurcation usually at the origin of proximal internal carotid artery (ICA). It contains baroreceptors which influence blood pressure. Variations in the location of the CS are of importance as atheromatous plaque commonly forms in this area and procedures such as carotid endarterectomy are performed to reduce the risk of stroke. Inadvertent stimulation of the CS baroreceptors during interventions can have profound effects on the patient’s haemodynamic status both intra- and postoperatively, causing serious complications. The aim of this study is to determine the inter- and intra-individual variations in the location of the CS. Materials and methods: Eighty-two carotid arteries were dissected bilaterally from 41 cadavers. The locations of the CS were noted and divided into four potential sites. Results: The commonest site is the origin of the ICA (74.3%), but the CS can also be found in the distal part of the common carotid artery (CCA) inferior to the bifurcation (17.1%); at the bifurcation involving the distal CCA and origins of both the external carotid artery (ECA) and ICA (7.32%); and at the origin of the ECA (1.22%). In individual cadavers, the CS was located at the origin of the ICA in 97.6% on at least one side. The sites of the CS were asymmetrical in 34.1%. Conclusions: Clinicians performing carotid interventions should be aware of these anatomical variations to avoid inadvertent stimulation of the CS which can cause profound bradycardia and hypotension. (Folia Morphol 2018; 77, 4: 693–697)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2018
• Tom: 77
• Numer: 4
• Opis fizyczny: p.693–697,fig.,ref.

Twórcy

autor

West C.T.

• Digestive Diseases Department, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom
• Digestive Diseases Department, Surrey and Sussex NHS Healthcare Trust, United Kingdom

autor

Brassett C.

• Digestive Diseases Department, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom

autor

Gaunt M.E.

• Digestive Diseases Department, East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, United Kingdom

Bibliografia

• 1. Ajduk M, Tudorić I, Sarlija M, et al. Effect of carotid sinus nerve blockade on hemodynamic stability during carotid endarterectomy under local anesthesia. J Vasc Surg. 2011; 54(2): 386–393, doi: 10.1016/j.jvs.2011.02.036, indexed in Pubmed: 21658884.
• 2. Binswanger O. Anatomische Untersuchungen über die Ursprungsstelle und den Anfangstheil der Carotis interna. Archiv für Psychiatrie und Nervenkrankheiten. 1879; 9(2): 351–368, doi: 10.1007/bf02666476.
• 3. Boyd JD. Observations on the human carotid sinus and its nerve supply. Anatomischer Anzeiger. 1937; 84: 386–399.
• 4. Cao Q, Zhang J, Xu G. Hemodynamic changes and baroreflex sensitivity associated with carotid endarterectomy and carotid artery stenting. Interv Neurol. 2015; 3(1): 13–21, doi: 10.1159/000366231, indexed in Pubmed: 25999987.
• 5. Cayne NS, Faries PL, Trocciola SM, et al. Carotid angioplasty and stent-induced bradycardia and hypotension: Impact of prophylactic atropine administration and prior carotid endarterectomy. J Vasc Surg. 2005; 41(6): 956–961, doi: 10.1016/j.jvs.2005.02.038, indexed in Pubmed: 15944593.
• 6. Choi SS, Lim YJ, Bahk JH, et al. Coronary artery spasm induced by carotid sinus stimulation during neck surgery. Br J Anaesth. 2003; 90(3): 391–394, doi: 10.1093/bja/aeg051.
• 7. Dehn T, Angell-James JE. Long-term effect of carotid endarterectomy on carotid sinus baroreceptor function and blood pressure control. Br J Surg. 1987; 74(11): 997–1000, doi: 10.1002/bjs.1800741113.
• 8. Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954; 267(6846): 994–996, doi: 10.1016/S0140-6736(54)90544-9, indexed in Pubmed: 13213095.
• 9. Hirschl M, Kundi M, Hirschl M, et al. Blood pressure responses after carotid surgery: Relationship to postoperative baroreceptor sensitivity. Am J Med. 1993; 94(5): 463–468, doi: 10.1016/0002-9343(93)90079-5.
• 10. Kurkcuoglu A, Aytekin C, Oktem H, et al. Morphological variation of carotid artery bifurcation level in digital angiography. Folia Morphol. 2015; 74(2): 206–211, doi: 10.5603/FM.2015.0032, indexed in Pubmed: 26050808.
• 11. Leisch F, Kerschner K, Hofmann R, et al. Carotid sinus reactions during carotid artery stenting: predictors, incidence, and influence on clinical outcome. Catheter Cardiovasc Interv. 2003; 58(4): 516–523, doi: 10.1002/ccd.10483, indexed in Pubmed: 12652504.
• 12. Lucev N, Bobinac D, Maric I, et al. Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg. 2000; 122(4): 590–591, doi: 10.1067/mhn.2000.97982, indexed in Pubmed: 10740186.
• 13. Marrocco-Trischitta MM, Cremona G, Lucini D, et al. Peripheral baroreflex and chemoreflex function after eversion carotid endarterectomy. J Vasc Surg. 2013; 58(1): 136–44.e1, doi: 10.1016/j.jvs.2012.11.130, indexed in Pubmed: 23632295.
• 14. Michalinos A, Chatzimarkos M, Arkadopoulos N, et al. Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int. 2016; 2016: 6907472, doi: 10.1155/2016/6907472, indexed in Pubmed: 27047690.
• 15. Nishizaki M, Yamawake N, Arita M. Coronary artery spasm induced by carotid sinus massage. Heart. 2000; 84(1): E2, doi: 10.1136/heart.84.1.e2, indexed in Pubmed: 10862603.
• 16. Schulz U, Rothwell PM. Major variation in carotid bifurcation anatomy: a possible risk factor for plaque development? Stroke. 2001; 32(11): 2522–2529, doi: 10.1161/hs1101.097391.
• 17. Sigaudo-Roussel D, Evans DH, Naylor AR, et al. Deterioration in carotid baroreflex during carotid endarterectomy. J Vasc Surg. 2002; 36(4): 793–798, doi: 10.1067/mva.2002.126564, indexed in Pubmed: 12368741.
• 18. Smith D, Larsen JL. On the symmetry and asymmetry of the bifurcation of the common carotid artery: a study of bilateral carotid angiograms in 100 adults. Neuroradiology. 1979; 17(5): 245–247, doi: 10.1007/BF00337533, indexed in Pubmed: 481739.
• 19. Tang TY, Walsh SR, Gillard JH, et al. Carotid sinus nerve blockade to reduce blood pressure instability following carotid endarterectomy: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2007; 34(3): 304–311, doi: 10.1016/j.ejvs.2007.02.024, indexed in Pubmed: 17509910.
• 20. Toorop RJ, Ousrout R, Scheltinga MRM, et al. Carotid baroreceptors are mainly localized in the medial portions of the proximal internal carotid artery. Ann Anat. 2013; 195(3): 248–252, doi: 10.1016/j.aanat.2012.12.001, indexed in Pubmed: 23452666.
• 21. Toorop RJ, Scheltinga MR, Moll FL, et al. Anatomy of the carotid sinus nerve and surgical implications in carotid sinus syndrome. J Vasc Surg. 2009; 50(1): 177–182, doi: 10.1016/j.jvs.2009.03.029, indexed in Pubmed: 19563966.
• 22. Toorop RJ, Visser RF, Moll FL, et al. Long term safety and efficacy of internal carotid artery adventitial stripping in carotid sinus syndrome. Curr Hypertens Rev. 2014; 10(1): 58–64, doi: 10.2174/157340211001141111161240, indexed in Pubmed: 25392145.
• 23. Yip HK, Sung PH, Wu CJ, et al. Carotid stenting and endarterectomy. Int J Cardiol. 2016; 214: 166–174, doi: 10.1016/j.ijcard.2016.03.172, indexed in Pubmed: 27061654.
• 24. Zhang C, Xie S, Li S, et al. Flow patterns and wall shear stress distribution in human internal carotid arteries: the geometric effect on the risk for stenoses. J Biomech. 2012; 45(1): 83–89, doi: 10.1016/j.jbiomech.2011.10.001, indexed in Pubmed: 22079384.

Identyfikatory

DOI

10.5603/FM.a2018.0017