External Carotid Artery: Imaging Anatomy Atlas for Endovascular Treatment

This atlas presents the detailed anatomy of the external carotid arterial branches for interventional radiology.

In the last decade, interventional neuroradiology (endovascular treatment via the cerebral arteries) has advanced rapidly thanks to the development of new technological devices, such as detachable coils for brain aneurysm. Anatomical knowledge of the target vessels is essential for interventional neuroradiology, and innovative new imaging techniques like 3D angiography and image fusion techniques can depict the detailed anatomy of small vessels together with surrounding organs. This compilation provides not only 2D angiography images, but also 3D and cross-sectional images, as well as fusion images mainly based on 3D angiography, CT and MRI to further readers’ understanding of the complicated anatomy of the small branches of the external carotid artery. It also describes the branches’ clinical significance in endovascular treatment.

The book offers a valuable resource for interventional neuroradiologists, neurosurgeons and neurologists, as well as otolaryngologists, plastic surgeons, radiology technicians, and all medical staff involved in interventional radiology. 

• Language: English
• Publisher: Springer
• Release date: Jun 12, 2020
• ISBN: 9789811547867

Book preview

Editor

Hiro Kiyosue

External Carotid Artery

Imaging Anatomy Atlas for Endovascular Treatment

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Editor

Hiro Kiyosue

Department of Radiology, Oita University Hospital, Yufu, Oita, Japan

ISBN 978-981-15-4785-0e-ISBN 978-981-15-4786-7

https://doi.org/10.1007/978-981-15-4786-7

© Springer Nature Singapore Pte Ltd. 2020

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Contents

1 External Carotid Artery 1

Hiro Kiyosue

2 Anterior (Visceral) Branches from the Proximal ECA (Superior Thyroidal, Lingual, and Facial Arterial System) 7

Hiro Kiyosue

3 Posterior (Neural) Branches from the Proximal ECA 37

Hiro Kiyosue and Yuji Matsumaru

4 Superficial Arteries from the Distal ECA 75

Hiro Kiyosue

5 Maxillary Artery 109

Hiro Kiyosue and Shuichi Tanoue

© Springer Nature Singapore Pte Ltd. 2020

H. Kiyosue (ed.)External Carotid Arteryhttps://doi.org/10.1007/978-981-15-4786-7_1

1. External Carotid Artery

Hiro Kiyosue¹  

(1)

Department of Radiology, Oita University Hospital, Oita, Japan

Hiro Kiyosue

Email: [e-mail]

The external carotid artery (ECA) gives off various branches supplying musclocutaneous organs, visceral organs (pharynx, oral cavity, larynx, and thyroid), cranial nerves, facial and skull bones, and dura matter. It communicates to the cerebral arteries and ophthalmic artery via various potential anastomoses. It is essential for successful and safe endovascular treatment to know imaging anatomy of the ECA and its branches particularly these potential anastomoses and cranial nerve supply.

The external carotid artery (ECA) generally originates anteromedially from the common carotid artery at the level of C4. The ECA gives off the superior thyroid artery inferiorly at its origin, and runs superiorly toward the parotid gland with giving off the lingual artery and the facial artery anteriorly, the occipital artery, the ascending pharyngeal artery, and the posterior auricular artery posterosuperiorly. After it penetrates the parotid gland, it bifurcates into two terminal branches of the superficial temporal artery and the maxillary artery at the level of mandibular neck (Figs. 1.1 and 1.2).

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Fig. 1.1

Schematic drawing of the external carotid artery and its major branches. SThA, superior thyroid artery; ICA, internal carotid artery; ECA, external carotid artery; LA, lingual artery; Facial A, facial artery; APA, ascending pharyngeal artery; APalA, ascending palatine artery; OA, occipital artery; PAA, posterior auricular artery; STA, superficial temporal artery; TFA, transverse facial artery; MMA, middle meningeal artery; AMA, accessory meningeal artery; IDA, inferior dental artery; MDTA, middle deep temporal artery; Max, maxillary artery; ADTA, anterior deep temporal artery; DPA, deep palatine artery; PSDA, posterior superior dental artery; IOA, inferior orbital artery; SPA, sphenopalatine artery; 1, artery of superior orbital fissure; 2, artery of foramen rotundum; 3, artery of pterygoid canal (vidian artery); 4, pharyngeal artery (pterygovaginal artery)

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Fig. 1.2

Angiographic images of the right external carotid artery in a case of occlusion of the right internal carotid artery. Right lateral view (a) and left lateral view (b) of the 3D VR images and, and right anterior oblique view (c) of the common carotid angiography. SThA, superior thyroid artery; ICA, internal carotid artery; ECA, external carotid artery; LA, lingual artery; Facial A, facial artery; APA, ascending pharyngeal artery; APalA, ascending palatine artery; OA, occipital artery; PAA, posterior auricular artery; STA, superficial temporal artery; TFA, transverse facial artery; MMA, middle meningeal artery; AMA, accessory meningeal artery; IDA, inferior dental artery; MDTA, middle deep temporal artery; Max, maxillary artery; ADTA, anterior deep temporal artery; DPA, deep palatine artery; LPA, lesser palatine artery; GPA, greater palatine artery; PSDA, posterior superior dental artery; IOA, inferior orbital artery; SPA, sphenopalatine artery; MMA-OA, anastomosis between the anterior branch of the middle meningeal artery and the ophthalmic artery

Branches of the ECA are delivered from the remnants of the embryological arteries including the 1st and the 2nd aortic arch (communicating between the ventral and dorsal aorta) and carotid-vertebrobasilar anastomoses (communicating between the dorsal aorta and the vertebral/basilar artery) [1–3]. Therefore, various potential anastomoses exist between the ECA and the internal carotid artery or vertebrobasilar artery. Six paired aortic arches are formed between the ventral aorta and dorsal aorta in the six pharyngeal arches at early embryo. These aortic arches are formed in order from cranial to caudal, and the 1st and 2nd aortic arch becomes arterial plexus and then regressed. The dorsal aorta cranial to the third aortic arch becomes the internal carotid artery. The remnants of ventral parts of arterial plexus from the 1st and the 2nd aortic arch form some of the branches of the ECA (Fig. 1.3). The proximal portion of the second arch forms the ventral pharyngeal artery further becoming the trunk of the facial and lingual artery. Carotid-vertebrobasilar anastomoses is another important communication in embryo, which exist between the dorsal aorta and the vertebra-basilar artery. Carotid-vertebrobasilar anastomoses include primitive trigeminal artery, primitive otic artery, primitive hypoglossal artery, and the 1st and 2nd proatlantal arteries. The carotid-vertebrobasilar anastomoses regress and disappear according to the development of vertebrobasilar arterial system except for case of rare anatomical variant. The ascending pharyngeal artery and the occipital artery are partially formed from the primitive hypoglossal artery and the proatlantal artery, respectively. The middle meningeal artery and the maxillary artery are formed from ventral part of the remnant arterial plexus of the 1st and 2nd aortic arch which connect with the hyoid artery (dorsal stem of the remnant second aortic arch) via a transient embryologic artery called the stapedial artery. The stapedial artery runs through the stapes in the tympanic cavity and is divided into two terminal branches of supraorbital division and maxillomandibular division. The former becomes the middle meningeal artery and the later becomes the maxillary artery. The stapedial artery regresses and disappears according to the development of the stem of the ECA, and the residual parts of the stapedial artery becomes small branches the ECA distribute the tympanic cavity. As described above, the ECA is formed by various process of the regression of the 1st and 2nd aortic arch and the arterial plexus, embryological anastomoses, and formation of newly developed arterial routes, and therefore, various potential anastomoses and several anatomical variations can exist.

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Fig. 1.3

Embryonic development of external carotid artery. Schematic drawing of (a) CRL 4 mm, (b) CRL 9 mm, and (c) CRL 18 mm embryo (d) after birth. (a) DorA, dorsal aorta; 1st, first aortic arch; 2nd, second aortic arch; 3rd, third aortic arch; 4th, forth aortic arch; 6th, 6th aortic arch; C1, 1st cervical spinal nerve; VentA ventral aorta; PMaxA, primitive maxillary artery; POlfA, primitive olfactory artery; OpV, optic vesicle; Cranial div, cranial division; Caudal div, caudal division; V-XII,5th–12th cranial nerves; OtV, otic vesicle; PTA, primitive trigeminal artery; POA, primitive otic artery; PHA, primitive hypoglossal artery; PPA. Primitive proatlantal artery. (b) DA, dorsal aorta; 1st, first aortic arch; 2nd, second aortic arch; 3rd, third aortic arch; 4th, forth aortic arch; C1, 1st cervical spinal nerve; PMaxA, primitive maxillary artery; POlfA,