Incidence and risk factors of the retropharyngeal carotid artery on cervical magnetic resonance imaging

Spine (Phila Pa 1976). 2013 Jan 15;38(2):E109-12. doi: 10.1097/BRS.0b013e31827b0d4b.


Study design: Retrospective cohort.

Objective: Define incidence of anomalous carotid vasculature and associated risk factors as pertains to the anterior approach.

Summary of background data: The carotid artery system, including the common, internal, and external branches, is lateral to the foramen transversarium. If unrecognized, aberrancies in carotid vessel anatomy can lead to devastating complications.

Methods: A total of 1000 cervical magnetic resonance imagings were screened to localize the carotid artery respective to medial/lateral location of the vessel at each segment from C2-C3 to C6-C7 bilaterally. Vessel location was classified in 3 zones: lateral to the vertebral foramen (type I) (normal); between the lateral foramen and uncoverterbral joint (type II); and medial to the uncovertebral joint (type III). Type III locations were compared with age-matched controls for assessment of cervical alignment via the Ishihara index, C2-C7 angle, and degree of spondylosis.

Results: A total of 123 patients demonstrated carotid artery anomalies (type II and III) (12.3%). Twenty-six patients had type III aberrancy (2.6%). Patients with anomalies were significantly older and more likely to be female (60 vs. 51 yr of age, 74% vs. 57% female, respectively, P < 0.05). The type III group average age was 66.1 years and 88% were female. Aberrancies were more likely right-sided and at C3-C4 or cranial. C2-C7 angle showed significantly greater kyphosis in patients with anomalies compared with controls (6.2 vs. 14.4, P = 0.03). The number of severely spondolytic segments was significantly greater in patients with Type III locations than controls (2.0 vs. 1.1 P < 0.05).

Conclusion: Carotid arterial anomalies occurred in 12.3% of cases; severe aberrancy was present in 2.6% of patients. In elderly females with kyphotic alignment, a high index of suspicion must be raised for aberrancy. Preoperative assessment of the vasculature in the anterior neck may avoid catastrophic complications.

MeSH terms

  • Aged
  • Cardiovascular Abnormalities / complications*
  • Cardiovascular Abnormalities / epidemiology
  • Cardiovascular Abnormalities / pathology
  • Carotid Arteries / abnormalities*
  • Carotid Artery Injuries / epidemiology
  • Cervical Vertebrae / anatomy & histology*
  • Cervical Vertebrae / surgery
  • Female
  • Humans
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / etiology*
  • Intraoperative Complications / pathology
  • Intraoperative Complications / prevention & control
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neck / anatomy & histology*
  • Neck / surgery
  • Retrospective Studies
  • Risk Factors