Variabilitatea anatomică a nivelului de bifurcare a arterei carotide comune

Abstract

Introducere. Creşterea incidenţei aterosclerozei şi a accidentului vascular cerebral, s-a soldat cu sporirea numărului intervenţiilor chirurgicale la nivelul arterei carotide comune (ACC), condiţionând noi standarde intervenţionale, bazate pe cunoaşterea variabilităţii anatomice, inclusiv a nivelului ei de bifurcare. Scop şi obiective. Scopul lucrării noastre a fost determinarea nivelului topografic de bifurcare (NB) a arterei carotide comune în raport cu vertebrele cervicale şi unghiul mandibulei (UM). Material şi metode. Nivelul de bifurcare a arterei carotide comune a fost studiat retrospectiv pe un eşantion de 200 pacienţi [117 bărbaţi (B)/84 femei (F)] cu vârsta medie (B - 63,6±13,49/F - 64,2±14,66), p=0,754, investigaţi prin angio-CT în perioada 2020-2024, în cadrul Institutul de Medicină Urgentă şi Centrul Republican de Diagnosticare Medicală. Rezultate. Raportul dreapta/stânga (D/S) de bifurcare a ACC: C4 - 31,5%/28%; C3 - 27,5%/28%; C3-C4 - 20,5%/24%. Bifurcarea înaltă (BÎ) D/S - 6,5%/7,5%. BÎ ACC stângă (ACCS) preponderent - C2-C3 (5,5%), iar ACC dreaptă (ACCD) - C2 (2,0%). Bifurcarea joasă (BJ) a predominat la nivelul C5, D/S - 4,5%/5,5%. Raport B/F a BÎ a ACCD a fost de 3,5%/3%, iar pentru ACCS, a câte 3% la ambele sexe. Raportul D/S a bifurcării ACC la nivelul UM - 3,0%/4,5%, mai frecvent la F. Distanţa dintre bifurcarea ACCD şi UM la B - 2,5±1,17 cm, la F - 2,2±1,05 cm, (p=0,039). Media distanţei dintre bifurcarea ACCS şi UM la B - 2,3±1,16 cm, la F - 1,9±1,07 cm, (p=0,042). Concluzii. Cunoaşterea variantelor nivelului de bifurcare a arterei carotide comune în raport cu structurile adiacente are o importanţă clinică majoră. Identificarea preoperatorie a NB ar minimaliza esenţial riscurile intraoperatorii şi ar permite abordarea chirurgicală individualizată.

Introduction. The high incidence of the carotid atherosclerosis and stroke has led to an increasing number of surgical interventions on the common carotid artery (CCA). The new interventional standards are based on anatomical variability, including knowledge about the level of common carotid bifurcation. Objective. The purpose of our study was to determine the topographic level of the common carotid artery bifurcation (CCAB), related to cervical vertebrae and to the angle of the mandible (AM). Material and methods. The common carotid artery bifurcation was studied retrospectively on a sample size of 200 patients [117 males (M)/84 females (F)] with an average age (M - 63.6±13.49/F - 64.2±14.66), p=0.754, who were examined by CT angiography, during the period 2020-2024, at the Institute of Emergency Medicine and Republican Center for Medical Diagnostics. Results. The right/left (R/L) level of the CCAB was as follows: C4 - 31.5%/28%; C3 - 27.5%/28%; C3-C4 -20.5%/24%. The high CCAB had a R/L ratio of 6.5%/7.5%. The high left CCAB predominated at C2-C3 (5.5%), while the right CCAB - at C2 (2.0%). Low bifurcation (LB) was found at C5, with a R/L ratio of 4.5%/5.5%. M/F ratio of high right CCAB was 3.5%/3%, and of the left CCAB - 3% for each gender. R/L ratio of the CCAB at the AM was 3.0%/4.5%, more frequent revealed in F. Distance between the right CCAB and AM in M was 2.5±1.17 cm, in F - 2.2±1.05 cm, (p=0.039). Mean distance between left CCAB and AM in M was 2.3±1.16 cm, in F - 1.9±1.07 cm, (p=0.042). Conclusion. Knowledge about variants of common carotid artery bifurcation in relation to the surrounding structures is of high clinical significance. Preoperative diagnostics of those variants would essentially minimize the intraoperative risk, allowing an individualized surgical approach.