PMC9458160_01
(A) Three-dimensional reconstruction of preoperative computed tomography angiography showing a high carotid bifurcation and a high cervical lesion. The level of the carotid bifurcation and the distal plaque end (white arrowhead) are located at the C2/3 vertebral body junction and the upper third of the C2 vertebra, respectively. (B) Intraoperative photograph of left carotid endarterectomy. The superior thyroid artery (black arrowhead) and the linguofacial trunk (black arrow) originate from the distal common carotid artery and carotid bifurcation, respectively. Dissection around the origins of the superior thyroid artery, linguofacial trunk, and external carotid artery was performed.
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The carotid bifurcation was located at the level of the C2/3 vertebral body junction, and the distal end of the plaque was positioned at the upper third of the C2 vertebra (Fig. 1A). The origins of the superior thyroid artery, linguofacial trunk, and external carotid artery (ECA) were widely dissected and exposed for cross-clamping to prevent back-bleeding during endarterectomy (Fig. 1B).
PMC9458160_02
(A) Lateral view of right preoperative carotid angiography shows a high carotid bifurcation and a high cervical lesion. The carotid bifurcation is located at the level of the C3 vertebra, and the distal plaque end is positioned at the middle third of the C2 vertebra (white arrowhead). (B) Intraoperative photograph of right carotid endarterectomy. The lingual (black arrowhead) and facial (black arrow) arteries branch off from the proximal ECA. Exposure of the ECA distal to the facial artery was obtained for clamping of the vessels. ECA, external carotid artery
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CEA for contralateral carotid artery stenosis was diagnosed with asymptomatic severe atherosclerotic stenosis between the right distal CCA and the origin of the ICA. Cervical angiography of the right CCA showed a high carotid bifurcation located at the level of the upper C3 vertebra, and an extensive lesion reached the level of the middle third of the C2 vertebra (Fig. 2A). Therefore, the operation required the exposure of the ECA distal to the lingual and facial arteries for clamping of the vessels (Fig. 2B).