Diagnostics2023Open Access

The axial spin of the carotid bifurcation

A bilateral imaging study showing that carotid bifurcations rotate through reproducible coronal, oblique, and sagittal configurations rather than obeying one fixed ICA–ECA arrangement.

Mihaela Daniela Manta · Mugurel Constantin Rusu · Sorin Hostiuc · Alexandra Diana Vrapciu · Bogdan Adrian Manta · Adelina Maria Jianu

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Central message

Two configurations account for more than four-fifths of carotid bifurcations.

SK2a (ECA anterior to ICA) and OK1 (ECA anteromedial to ICA) dominated the cohort, but their relative frequency differed between right and left sides.

82.33%combined prevalence of SK2a + OK1

01 · Cohort

Axial rotation is common and classifiable

Three hundred carotid bifurcations were assessed bilaterally in 150 patients. Six observed axial-spin types describe the relative ICA–ECA arrangement.

150

Patients

88 men and 62 women.

300

Bifurcations

Both sides analysed.

42.33%

SK2a

ECA anterior to ICA; most frequent overall.

40%

OK1

ECA anteromedial to ICA; second most frequent.

02 · Spin explorer

Six axial configurations

Select a type to compare its overall prevalence and right-versus-left distribution.

03 · Side pattern

The two dominant configurations exchange rank by side

SK2a prevailed on the right, whereas OK1 prevailed on the left. Bilateral symmetry was particularly strong for these two common configurations.

46.67%

Right SK2a

Compared with 38% on the left.

46.67%

Left OK1

Compared with 33.33% on the right.

Interpretation: a “lateralised ECA” is not a single entity. The axial geometry of the bifurcation should be described explicitly, especially for operative or endovascular planning.