Internal Carotid Artery

Profesor:Sinisa Babovic

Student:Rastko Radojicic
 Introduction
The internal carotid artery is a terminal branch of the common carotid artery. It arises most
frequently between C3 and C5 vertebral level, where the common carotid bifurcates to form
the internal carotid and the external carotid artery (ECA).Although the majority arise between
C3 and C5 vertebral level, a wide variation exists.C1/2: 0.3%,C2/3: 3.7%,C3/4: 34.2%,C4/5:
48.1%,C5/6: 13%,C6/7: 0.15%There may be significant asymmetry between left and right
ICA origins:level of bifurcation:left higher 50%,right higher 22%,same height
28%.Orientation of origin-dorsolateral or dorsal aspect of CCA: right 82% and left 94%. The
internal carotid runs vertically upward in the carotid sheath, and enters the skull through
the carotid canal. During this part of its course, it lies in front of the transverse processes of
the upper three cervical vertebrae.
 Course

It is relatively superficial at its start, where it is contained in the carotid triangle of the neck,
and lies behind and medial to the external carotid, overlapped by the sternocleidomastoid
muscle, and covered by the deep fascia, the platysma, and integument: it then passes beneath
the parotid gland, being crossed by the hypoglossal nerve, the digastric muscle and
the stylohyoid muscle, the occipital artery and the posterior auricular artery. Higher up, it is
separated from the external carotid by the styloglossus and stylopharyngeus muscles, the tip
of the styloid process and the stylohyoid ligament, the glossopharyngeal nerve and the
pharyngeal branch of the vagus nerve. It is in relation, behind, with the longus capitis,
the superior cervical ganglion of the sympathetic trunk, and the superior laryngeal nerve;
laterally, with the internal jugular vein and vagus nerve, the nerve lying on a plane posterior
to the artery; medially, with the pharynx, superior laryngeal nerve, and ascending pharyngeal
artery. At the base of the skull the glossopharyngeal, vagus, accessory, and hypoglossal
nerves lie between the artery and the internal jugular vein.Unlike the external carotid artery,
the internal carotid normally has no branches in the neck.The internal carotid artery enters the
skull base through the carotid canal within the petrous portion of the temporal bone and
ascends within the cavernous sinus.
Once it exits the cavernous sinus it courses intracranially over the anterior clinoid process
and terminates in a T junction giving rise to the anterior cerebral artery medially and the
middle cerebral artery laterally. (Circle of Willis)
 Segments
There are several classification systems, the most recent of which was described by
Bouthillier et al in 1996.Their classification system is used clinically by neurosurgeons,
neuroradiologists and neurologists and relies on the angiographic appearance of the vessel and
histological comparison rather than on the embryonic development.There are seven segments
in the Bouthillier classification:

1.cervical segment 2.petrous (horizontal) segment 3.lacerum segment 4.cavernous segment

5.clinoid segment 6.ophthalmic (supraclinoid) segment 7.communicating (terminal) segment
 Branches

C1: Branches from the cervical portion - none.

C2: Branches from the petrous portion

Caroticotympanic arteries

Artery of pterygoid canal (vidian artery)

C3: Branches from the lacerum portion - none

C4: Branches from the cavernous portion

Branches of the meningohypophyseal trunk:

Tentorial basal branch

Tentorial marginal branch

Meningeal branch - helps supply blood to the meninges of the anterior cranial fossa

Clivus branches - tiny branches that supply the clivus

Inferior hypophyseal artery

Capsular branches - supplies wall of cavernous sinus

Branches of the inferolateral trunk:

Branches to trigeminal ganglion - provide blood to trigeminal ganglion

Artery of the foramen rotundum

Branches to nerves

C5: Branches from the clinoid portion - none

C6: Branches from the ophthalmic portion

Ophthalmic artery

Superior hypophyseal artery

C7: Branches from the communicating portion

Posterior communicating artery

Anterior choroidal artery

Anterior cerebral artery (a terminal branch)

Middle cerebral artery (a terminal branch)

A useful mnemonic to remember the branches of the internal carotid artery is:
A VIP'S COMMA

Variant anatomy:aberrant ICA,congenital absence of the ICA,retropharyngeal ICA (rare) 4

,kissing carotids.persistent carotid-vertebrobasilar anastomoses,lateralised internal carotid
artery.(carotid artery pseudoaneurysm)

Dr Jeremy Jones et al. Dr Aditya Shetty and A.Prof Frank Gaillard et al. Radiopedia& R
Shane Tubbs, MS, PA-C, PhD; Chief Editor: Brian H Kopell, MD