open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-02-20
Submitted: 2017-10-23
Accepted: 2018-02-11
Get Citation

Variations in carotid sinus anatomy and their relevance to carotid interventions

C. T. West, C. Brassett, M. E. Gaunt
DOI: 10.5603/FM.a2018.0017
·
Pubmed: 29500893
·
Folia Morphol 2018;77(4):693-697.

open access

Vol 77, No 4 (2018)
ORIGINAL ARTICLES
Published online: 2018-02-20
Submitted: 2017-10-23
Accepted: 2018-02-11

Abstract

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.

Abstract

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.

Get Citation

Keywords

carotid sinus, carotid endarterectomy, common carotid artery, internal carotid artery, external carotid artery

About this article
Title

Variations in carotid sinus anatomy and their relevance to carotid interventions

Journal

Folia Morphologica

Issue

Vol 77, No 4 (2018)

Pages

693-697

Published online

2018-02-20

DOI

10.5603/FM.a2018.0017

Pubmed

29500893

Bibliographic record

Folia Morphol 2018;77(4):693-697.

Keywords

carotid sinus
carotid endarterectomy
common carotid artery
internal carotid artery
external carotid artery

Authors

C. T. West
C. Brassett
M. E. Gaunt

References (24)
  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.
  2. Binswanger O. Anatomische Untersuchungen über die Ursprungsstelle und den Anfangstheil der Carotis interna. Archiv für Psychiatrie und Nervenkrankheiten. 1879; 9(2): 351–368.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  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.
  14. Michalinos A, Chatzimarkos M, Arkadopoulos N, et al. Anatomical considerations on surgical anatomy of the carotid bifurcation. Anat Res Int. 2016; 2016: 6907472.
  15. Nishizaki M, Yamawake N, Arita M. Coronary artery spasm induced by carotid sinus massage. Heart. 2000; 84(1): E2.
  16. Schulz U, Rothwell PM. Major variation in carotid bifurcation anatomy: a possible risk factor for plaque development? Stroke. 2001; 32(11): 2522–2529.
  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.
  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.
  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.
  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.
  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.
  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.
  23. Yip HK, Sung PH, Wu CJ, et al. Carotid stenting and endarterectomy. Int J Cardiol. 2016; 214: 166–174.
  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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By  "Via Medica sp. z o.o." sp.k., Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl