• World Neurosurg · Oct 2024

    Radiographic Anatomy of the Common Carotid Artery for Direct Carotid Puncture.

    • Rahul B Singh, Ricardo A Domingo, Sukhwinder J S Sandhu, Ahmed K Ahmed, Jorge Rios-Zermeno, Andres Ramos-Fresnedo, Michael W Pullen, Gabriel M Virador, Carlos Perez-Vega, Jaime L Martinez Santos, Jorge A Abello-Vaamonde, Young Erben, Prasanna Vibhute, Vivek Gupta, Phillip Pirgousis, and Rabih G Tawk.
    • Department of Internal Medicine, New York City Health and Hospitals/South Brooklyn Health, Brooklyn, New York, USA.
    • World Neurosurg. 2024 Oct 1; 190: e859e867e859-e867.

    BackgroundDirect common carotid puncture (DCP) is conventionally used as a bailout technique in stroke patients. However, little is known about the relevant anatomy. Our objective was to examine the relationship of the common carotid artery (CCA) to surrounding structures based on different DCP trajectories passing through the artery's center.MethodsFifty randomly selected head/neck CTAs were analyzed. The trajectory of DCP and relationship to the internal jugular vein (IJV) and thyroid were analyzed at 1 cm intervals above the clavicle on 7 axial sections. Using the trans-carotid sagittal plane as the 0° trajectory, we plotted 3 additional trajectories at 30° intervals and the relationship with the IJV and thyroid proximity was graded as following: 0=absent, 1=adjacent, and 2=crossing. The CCA tortuosity index was also analyzed for each vessel.ResultsAnalysis of 2800 trajectories across 100 CCAs showed that the IJV and thyroid were least encountered on the axial sections 2 cm above the clavicle, at 0° on the right (9 thyroids and 6 IJV), and at 90° on the left (0 Thyroids and 14 IJVs). The tortuosity index of the CCA was significantly lower above the clavicle than its entire length (P < 0.001).ConclusionsDCP performed 2 cm above the clavicle at 0° on the right, and 90° on the left appears to minimize encounters with the IJV and thyroid gland, reducing potential complications. However, despite these findings, ultrasound guidance remains vital for DCP safety. Further focus on endovascular device safety in DCP is needed.Copyright © 2024 Elsevier Inc. All rights reserved.

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