Bilateral lower cervical bifurcation of the common carotid artery

Intrathoracic bifurcation of the left common carotid artery associated with rib fusion and Klippel-Feil syndrome

Common carotid artery usually bifurcates at the superior border of thyroid cartilage, corresponding to the C3-4 junction, however bifurcation level may vary. Common carotid bifurcation may have rare variations like separate origins of left internal and external carotid arteries from aortic arch, or bifurcation of common carotid artery within thoracic cavity. Intrathoracic carotid bifurcation is a rare variation with limited number of cases reported. The occurrence of a low carotid bifurcation seems to be embryologically related to the persistence of the ductus caroticus. Additionally, intrathoracic carotid bifurcation can be accompanied by findings of Klippel-Feil syndrome. Herein, we present imaging findings of an incidentally detected intrathoracic left common carotid artery bifurcation in a pediatric patient accompanied by fusion of the cervical vertebrae and ribs.

Treatment of a symptomatic intrathoracic internal carotid artery

Intrathoracic common carotid artery bifurcations are an anatomic anomaly with such rarity that only six cases have been reported to date. The true incidence of and preferred treatment options for a diseased intrathoracic common carotid artery bifurcation or internal carotid artery (ICA) have not been clearly described. This case report describes a 72-year-old man who experienced a postoperative right hemispheric stoke after an aortic valve replacement, radiofrequency maze procedure, and left atrial appendage clip. Postoperative cerebrovascular evaluation revealed a severely diseased intrathoracic ICA that was treated by ligation of the diseased proximal ICA and transposition of the distal ICA to the disease-free external carotid artery. The patient provided written consent to present the history, data, and images in this manuscript.