• Joji Tokugawa, Kentaro Kudo, Takashi Mitsuhashi, Naotake Yanagisawa, Shuko Nojiri, and Makoto Hishii.
• Department of Neurosurgery, Juntendo University Nerima Hospital, Tokyo, Japan. Electronic address: j.tokugawa@juntendo-nerima.jp.
• World Neurosurg. 2019 Jun 1; 126: e153-e156.

BackgroundThe internal carotid artery is normally positioned posterolateral to the external carotid artery at the carotid bifurcation. An anatomic variation with the internal carotid artery positioned medial to the external carotid artery, the so-called twisted carotid bifurcation (TCB), is sometimes encountered in patients undergoing carotid endarterectomy (CEA). Little is known about the TCB or the implications for CEA.ObjectiveThe present study investigated the demographics and surgical results of our patients with TCB who underwent CEA, and demonstrates the surgery in a video clip.MethodsEleven of our series of 73 consecutive CEA patients (15.1%) had a TCB (TCB group). The basic surgical method was the same for both the TCB and non-TCB groups.ResultsThe patient demographics were almost identical between the 2 groups. No significant difference was observed in the degree of stenosis, the duration of operation, or the surgery-related complications between the 2 groups. However, 9 of 11 cases were right-sided in the TCB group; the only significant difference between the groups.ConclusionsCEA 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 anatomic entity.Copyright © 2019 Elsevier Inc. All rights reserved.

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