Systematization of types of bifurcation of the common carotid artery taking into account geometrical and hemodynamic features

• Viktoriya P. Derbilova
• Roman A. Vinogradov
• Yuriy N. Zakharov
• Vladimir G. Borisov
• Elina E. Kheteeva
• El’vira R. Vinogradova
• Pavel K. Tyutyunikov
• Olga M. Meshcheryakova
• Vladimir A. Gagin
• Irina G. Voronova
• Elena I. Zyablova
• Alexander G. Baryshev

Abstract

Objective. The purpose was to study different types of the common carotid artery bifurcation, taking into account the characteristics of geometry and hemodynamics to predict the risk of developing atherosclerosis and postoperative restenosis.

Patients and methods. At the State Budgetary Healthcare Institution “Research Institute – Regional Clinical Hospital № 1 named after Professor S.V. Ochapovsky” with the support of the Kemerovo State University, a retrospective non-randomized single-center study was conducted, assessing the findings of multislice computed tomography of patients examined in the clinic from 2021 to 2022. The inclusion criteria were intact brachiocephalic arteries at the extracranial level. The study comprised a total of 85 bifurcations of the common carotid artery (CCA) with no atherosclerotic stenosis, dysplastic diseases, vasculitis, nor pathological tortuosity of the internal carotid artery (ICA). The following geometric data were studied: the diameters of the common and internal carotid arteries, the bifurcation angle of the common carotid artery, delta and diameter ratio, with the shape of the bulb of the internal carotid artery also assessed. Three-dimensional models of the bifurcation were constructed, the conditions of blood flow in these models were created, and, using specialized software, hemodynamic parameters responsible for the formation of conditions for the growth of an atherosclerotic plaque were calculated.

Results. Having analyzed the geometric and hemodynamic data in the area of the bifurcation of the common carotid artery in patients without pathology, we came to the conclusion that it is advisable to divide the entire variety of bifurcations of the CCA into groups according to the potential risk of developing atherosclerosis. Types of bifurcation with a high and low risk of atherosclerotic plaque formation were identified, with the bifurcations also divided into types depending on the location of risk zones.

Conclusion. Stratification of the risk of atherosclerosis is useful from the point of view of implementing a personalized approach to the management of patients with subclinical forms of atherosclerosis. The criteria making it possible to identify geometric signs of the risk of developing atherosclerosis can also be used in surgical decision-making in order to improve postoperative outcomes.

Финансирование. Исследование поддержано финансированием Кубанского научного фонда и частично реализовано за счет средств гранта Кубанского научного фонда в рамках проекта № НИП-20.1/22.11.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Вклад авторов. Концепция и дизайн исследования – Дербилова В.П., Виноградов Р.А.; разработка методологии – Захаров Ю.Н., Борисов В.Г., Дербилова В.П.; сбор и обработка материала – Хетеева Э.Э. Виноградова Э.Р., Тютюников П.К., Мещерякова О.М., Гагин В.А., Воронова И.Г.; статистическая обработка – Дербилова В.П.; написание текста – Дербилова В.П.; редактирование – Виноградов Р.А., Барышев А.Г.

Для цитирования: Дербилова В.П., Виноградов Р.А., Захаров Ю.Н., Борисов В.Г., Хетеева Э.Э., Виноградова Э.Р., Тютюников П.К., Мещерякова О.М., Гагин В.А., Воронова И.Г., Зяблова Е.И., Барышев А.Г. Систематизация типов бифуркации общей сонной артерии с учетом геометрических и гемодинамических особенностей. Ангиология и сосудистая хирургия. Журнал имени академика А.В. Покровского. 2025; 31 (1): 48–57. DOI: https://doi.org/10.33029/1027-6661-2025-31-1-48-57

Keywords: carotid artery bifurcation; computer modeling; carotid artery geometry; intravascular hemodynamics; atherosclerosis, wall shear stress