Skip to main content
SpringerLink
Log in

Anatomically specific clinical examination of the carotid arterial tree

  • Original article
  • Published:
Anatomical Science International Aims and scope Submit manuscript

Abstract

Clinical examination of the carotid arterial system has traditionally been used as a non-specific screening tool of atherosclerotic pathology. Because it has not yet been shown to delineate the precise location and grade of stenosis, further imaging modalities, such as duplex ultrasound, digital subtraction angiography, computed tomography and magnetic resonance, are currently used to obtain this information. These, however, have been shown to be susceptible to inaccuracies. Herein, a new protocol for bedside clinical examination that may define anatomical locality and degree of disease is presented. This consists of palpating the carotid pulse and auscultating for bruits along the course of the common carotid, internal carotid and external carotid arteries, as defined by surface anatomical landmarks from the lower neck to the pharynx. This protocol is not to replace more conventional methods of disease assessment but, in an era of diminishing clinical skills, may add to the overall evaluation of the pathological carotid tree.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Affeld K, Goubergrits L, Fernandez-Britto J, Falcon L (1998) Variability of the geometry of the human common carotid artery. A vessel cast study of 31 specimens. Pathol Res Pract 194, 597–602.

    PubMed  CAS  Google Scholar 

  • Balzer K (2004) [Treatment of carotid stenosis: Carotid surgery or stent? In favor of operation]. Herz 29, 90–103 (in German).

    Article  PubMed  Google Scholar 

  • Barnett HJ, Taylor DW, Eliasziw M et al. (1998) Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339, 1415–25.

    Article  PubMed  CAS  Google Scholar 

  • Best IM, Bumpers HL (2002) Anomalous origins of the right vertebral, subclavian, and common carotid arteries in a patient with a four-vessel aortic arch. Ann Vasc Surg 16, 231–4.

    Article  PubMed  Google Scholar 

  • Cakirer S, Karaarslan E, Kayabali M, Rozanes I (2002) Separate origins of the left internal and external carotid arteries from the aortic arch: MR angiographic findings. AJNR Am J Neuroradiol 23, 1600–2.

    PubMed  Google Scholar 

  • Choi G, Han SH, Choi JO (1998) Tortuous common carotid artery encountered during neck dissection. Eur Arch Otorhinolaryngol 255, 269–70.

    Article  PubMed  CAS  Google Scholar 

  • Chou HC, Wu TL (1993) Mandibulohyoid distance in difficult laryngoscopy. Br J Anaesth 71, 335–9.

    Article  PubMed  CAS  Google Scholar 

  • Currie IC, Jones AJ, Wakeley CJ et al. (1995) Non-invasive aortoiliac assessment. Eur J Vasc Endovasc Surg 9, 24–8.

    Article  PubMed  CAS  Google Scholar 

  • Dahn MS, Kaurich JD, Brown FR (1999) Independent origins of the internal and external carotid arteries: A case report. Angiology 50, 755–60.

    Article  PubMed  CAS  Google Scholar 

  • Debernardi S, Martincich L, Lazzaro D, Comelli S, Raso AM, Regge D (2004) CT angiography in the assessment of carotid atherosclerotic disease: Results of more than two years’ experience. Radiol Med 108, 116–27.

    PubMed  Google Scholar 

  • Dunning HS (1953) Detection of occlusion of the internal carotid artery by pharyngeal palpation. JAMA 152, 321.

    CAS  Google Scholar 

  • Ertl-Wagner B, Bruning R, Hoffmann RT, Meimarakis G, Reiser MF (2004) [Diagnostic evaluation of carotid artery stenoses with multislice CT angiography. Review of the literature and results of a pilot study]. Radiologe 44, 960–6 (in German).

    Article  PubMed  CAS  Google Scholar 

  • European Carotid Surgery Trialists’ Collaborative Group (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 351, 1379–87.

    Article  Google Scholar 

  • French JW, Guntheroth WG (1970) An explanation of asymmetric upper extremity blood pressures in supravalvular aortic stenosis: The Coanda effect. Circulation 42, 31–6.

    PubMed  CAS  Google Scholar 

  • Furst G, Saleh A, Wenserski F et al. (1999) Reliability and validity of noninvasive imaging of internal carotid artery pseudoocclusion. Stroke 30, 1444–9.

    PubMed  CAS  Google Scholar 

  • Gailloud P, Murphy KJ, Rigamonti D (2000) Bilateral thoracic bifurcation of the common carotid artery associated with Klippel-Feil anomaly. AJNR Am J Neuroradiol 21, 941–4.

    PubMed  CAS  Google Scholar 

  • Gailloud P, Carpenter J, Heck DV, Murphy KJ (2004) Pseudofe- nestration of the cervical internal carotid artery: A pathologic process that simulates an anatomic variant. AJNR Am J Neuroradiol 25, 421–4.

    PubMed  Google Scholar 

  • Garner C, Saver JL, Quinones-Baldrich WJ (1999) Pseudoocclusion and/or pseudo-stenosis of the intracranial internal carotid artery. Ann Vasc Surg 13, 629–33.

    Article  PubMed  CAS  Google Scholar 

  • Given II CA, Huang-Hellinger F, Baker MD, Chepuri NB, Morris PP (2001) Congenital absence of the internal carotid artery: Case reports and review of the collateral circulation. AJNR Am J Neuroradiol 22, 1953–9.

    PubMed  Google Scholar 

  • Gluncic V, Petanjek Z, Marusic A, Gluncic I (2001) High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery. Surg Radiol Anat 23, 123–5.

    Article  PubMed  CAS  Google Scholar 

  • Goldman L, Koller RL, Lebow SS, Loewenson RB, Anderson DC (1991) Cervical bruits: Clinical correlates of stenosis. Angiology 42, 491–7.

    Article  PubMed  CAS  Google Scholar 

  • Goubergrits L, Affeld K, Fernandez-Britto J, Falcon L (2002) Geometry of the human common carotid artery. A vessel cast study of 86 specimens. Pathol Res Pract 198, 543–51.

    Article  PubMed  CAS  Google Scholar 

  • Graham CA, Lewis NF (2002) Evaluation of a new method for the carotid pulse check in cardiopulmonary resuscitation. Resuscitation 53, 37–40.

    Article  PubMed  Google Scholar 

  • Gupta A, Winslet MC (2005) Tortuous common carotid artery as a cause of dysphagia. J R Soc Med 98, 275–6.

    Article  PubMed  Google Scholar 

  • Gurbuz J, Cavdar S, Ozdogmus O (2001) Trifurcation of the left common carotid artery: A case report. Clin Anat 14, 58–61.

    Article  PubMed  CAS  Google Scholar 

  • Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C (1975) Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. BMJ 2, 486–9.

    PubMed  CAS  Google Scholar 

  • Hayashi N, Hori E, Ohtani Y, Ohtani O, Kuwayama N, Endo S (2005) Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir 45, 25–9.

    Article  Google Scholar 

  • Herzig R, Burval S, Krupka B, Vlachova I, Urbanek K, Mares J (2004) Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses. Eur J Neurol 11, 774–81.

    Article  PubMed  CAS  Google Scholar 

  • Hess H, Elmagd AA (1992) [A rare variation in the zone of the carotid artery]. Ann Anat 174, 317–19 (in German).

    PubMed  CAS  Google Scholar 

  • Hu HH, Liao KK, Wong WJ et al. (1988) Ocular bruits in ischemic cerebrovascular disease. Stroke 19, 1229–33.

    PubMed  CAS  Google Scholar 

  • Josephson SA, Bryant SO, Mak HK, Johnston SC, Dillon WP, Smith WS (2004) Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA. Neurology 63, 457–60.

    PubMed  CAS  Google Scholar 

  • Kaneko K, Akita M, Murata E, Imai M, Sowa K (1996) Unilateral anomalous left common carotid artery; a case report. Ann Anat 178, 477–80.

    PubMed  CAS  Google Scholar 

  • Kappelle LJ, Eliasziw M, Fox AJ, Sharpe BL, Barnett HJ (1999) Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trial. Stroke 30, 282–6.

    PubMed  CAS  Google Scholar 

  • Kennedy J, Quan H, Ghali WA, Feasby TE (2004) Importance of the imaging modality in decision making about carotid endarterectomy. Neurology 62, 901–4.

    PubMed  Google Scholar 

  • Kopuz C, Turan R, Tekat A (1997) Unusual bifurcation-level variation of the left common carotid artery: Anatomic presentation of a surgical case. Morphologie 81, 13–14.

    PubMed  CAS  Google Scholar 

  • Lallemant B, Chevalier D, Dubrulle F, Mallet Y, Lallemant JG, Desaulty A. (2003) Anatomic variations of cervical internal carotid artery course: Surgical implications. J Otolaryngol 32, 119–21.

    Article  PubMed  Google Scholar 

  • Lucev N, Bobinac D, Maric I, Drescik I (2000) Variations of the great arteries in the carotid triangle. Otolaryngol Head Neck Surg 122, 590–1.

    Article  PubMed  CAS  Google Scholar 

  • Magyar MT, Nam EM, Csiba L, Ritter MA, Ringelstein EB, Droste DW (2002) Carotid artery auscultation: Anachronism or useful screening procedure? Neurol Res 24, 705–8.

    Article  PubMed  Google Scholar 

  • Mahadevan J, Batista L, Alvarez H, Bravo-Castro E, Lasjaunias P (2004) Bilateral segmental regression of the carotid and vertebral arteries with rete compensation in a Western patient. Neuroradiology 46, 444–9.

    Article  PubMed  CAS  Google Scholar 

  • Maybody M, Uszynski M, Morton E, Vitek JJ (2003) Absence of the common carotid artery: A rare vascular anomaly. AJNR Am J Neuroradiol 24, 711–13.

    PubMed  Google Scholar 

  • McKinney AM, Casey SO, Teksam M et al. (2005) Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography. Neuroradiology 47, 1–9.

    Article  PubMed  Google Scholar 

  • McLafferty RB, Dunnington GL, Mattos MA et al. (2000) Factors affecting the diagnosis of peripheral vascular disease before vascular surgery referral. J Vasc Surg 31, 870–9.

    Article  PubMed  CAS  Google Scholar 

  • Mikami T, Takahashi A, Houkin K (2005) Carotid rete mirabile associated with subarachnoid hemorrhage. Neurol Med Chir 45, 201–4.

    Article  Google Scholar 

  • Murie JA, Sheldon CD, Quin RO (1985) Radiographic anatomy of the extracranial carotid artery. J Cardiovasc Surg 26, 143–6.

    CAS  Google Scholar 

  • Nakaoka T, Matsuura H (2002) [Unilateral absence of the external carotid artery: Three case reports]. No Shinkei Geka 30, 1337–42 (in Japanese).

    PubMed  Google Scholar 

  • Nelson ML, Sparks CD (2001) Unusual aortic arch variation: Distal origin of common carotid arteries. Clin Anat 14, 62–5.

    Article  PubMed  CAS  Google Scholar 

  • Nonent M, Serfaty JM, Nighoghossian N et al. (2004) Concordance rate differences of 3 noninvasive imaging techniques to measure carotid stenosis in clinical routine practice: Results of the CARMEDAS multicenter study. Stroke 35, 682–6.

    Article  PubMed  Google Scholar 

  • Oates JW, McAuliffe W, Coates HL (1997) Management of pseudo-aneurysm of a lateral aberrant internal carotid artery. Int J Pediatr Otorhinolaryngol 42, 73–9.

    Article  PubMed  CAS  Google Scholar 

  • Olivarius BdeF (1965) The external carotid artery sign. Acta Neurol Scand 41, 539–50.

    Google Scholar 

  • Paulsen F, Tillmann B, Christofides C, Richter W, Koebke J (2000) Curving and looping of the internal carotid artery in relation to the pharynx: Frequency, embryology and clinical implications. J Anat 197, 373–81.

    Article  PubMed  Google Scholar 

  • Pessin MS, Panis W, Prager RJ, Millan VG, Scott RM (1983) Auscultation of cervical and ocular bruits in extracranial carotid occlusive disease: A clinical and angiographic study. Stroke 14, 246–9.

    PubMed  CAS  Google Scholar 

  • Prakash YS, Malouf JF (2004) Aberrant right common carotid artery: A diagnostic challenge on transesophageal echocar-diography. Int J Cardiovasc Imag 20, 217–19.

    Article  CAS  Google Scholar 

  • Ringer AJ, Salud L, Tomsick TA (2005) Carotid cavernous fistulas: Anatomy, classification, and treatment. Neurosurg Clin North Am 16, 279–95.

    Article  Google Scholar 

  • Rodriguez HE, Ziauddin MF, Podbielski FJ, Durham JR, Clark ET (2002) Congenital absence of the external carotid artery: Atherosclerosis without a bifurcation. J Vasc Surg 35, 573–5.

    Article  PubMed  Google Scholar 

  • Roll JD, Urban MA, Larson III TC, Gailloud P, Jacob P, Harns- berger HR (2003) Bilateral aberrant internal carotid arteries with bilateral persistent stapedial arteries and bilateral duplicated internal carotid arteries. AJNR Am J Neuroradiol 24, 762–5.

    PubMed  Google Scholar 

  • Rossitti S, Raininko R (2001) Absence of the common carotid artery in a patient with a persistent trigeminal artery variant. Clin Radiol 56, 79–81.

    Article  PubMed  CAS  Google Scholar 

  • Schulz UG, Rothwell PM (2001a) Major variation in carotid bifurcation anatomy: A possible risk factor for plaque development? Stroke 32, 2522–9.

    Article  PubMed  CAS  Google Scholar 

  • Schulz UG, Rothwell PM (2001b) Sex differences in carotid bifurcation anatomy and the distribution of atherosclerotic plaque. Stroke 32, 1525–31.

    Article  PubMed  CAS  Google Scholar 

  • Sehirli US, Yalin A, Tulay CM, Cakmak YO, Gurdal E (2005) The diameters of common carotid artery and its branches in newborns. Surg Radiol Anat 27, 292–6.

    Article  PubMed  Google Scholar 

  • Shaaf M, Cagle SK, Farris BK (1994) ‘Mickey Mouse’ aneurysm presenting with cranial bruit: Case report. Neurosurgery 35, 509–12.

    Article  PubMed  CAS  Google Scholar 

  • Simic P, Borovecki F, Jelic M, Jelic M, Vinter I (2004) Anomalous branch of the left common carotid artery. Clin Anat 17, 409–12.

    Article  PubMed  CAS  Google Scholar 

  • Struffert T, Grunwald I, Roth C, Reith W (2004) [Treatment of arteriosclerotic carotid stenosis: An overview]. Radiologe 44, 936–45 (in German).

    Article  PubMed  CAS  Google Scholar 

  • Suzuki T, Moriyama T, Moriwaki H, Yagihashi A, Yajima N, Taka- hashi G (2000) Anomalous artery directly connecting the external and internal carotid arteries. Ann Anat 182, 59–63.

    PubMed  CAS  Google Scholar 

  • Walsh DW, Ho VB, Borke RC, Rovira MJ (1998) Anomalous course of the common carotid arteries: CT and MRA illustration. A case report. Angiology 49, 235–8.

    Article  PubMed  CAS  Google Scholar 

  • Wang CP, Hsiao JK, Ko JY (2004) Splaying of the carotid bifurcation caused by a cervical sympathetic chain schwan- noma. Ann Otol Rhinol Laryngol 113, 696–9.

    PubMed  Google Scholar 

  • Windfuhr JP (2004) Aberrant internal carotid artery in the middle ear. Ann Otol Rhinol Laryngol Suppl 192, 1–16.

    PubMed  Google Scholar 

  • Yamamoto S, Watanabe M (2004) Novel collateral connecting the external and internal carotid arteries. Clin Anat 17, 70–2.

    Article  PubMed  Google Scholar 

  • Zumre O, Salbacak A, Cicekcibasi AE, Tuncer I, Seker M (2005) Investigation of the bifurcation level of the common carotid artery and variations of the branches of the external carotid artery in human fetuses. Ann Anat 187, 361–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Vascular and Cardiothoracic Surgery, Regional Vascular Unit at St Mary’s Hospital and the Royal Brompton Hospital, London, UK

    Hutan Ashrafian

Authors
  1. Hutan Ashrafian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hutan Ashrafian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ashrafian, H. Anatomically specific clinical examination of the carotid arterial tree. Anato Sci Int 82, 16–23 (2007). https://doi.org/10.1111/j.1447-073X.2006.00152.x

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1447-073X.2006.00152.x

Key words

Search

Navigation