Abstract

The development, significance and function of the human carotid sinus is not yet well understood. The arterial wall within the carotid sinus is well enervated and it contains baroreceptive neural terminals. One hypothesis that was put forward is that the dilation, which may involve all vessels of the carotid bifurcation, exists to support pressure sensing1. Another hypothesis that is supported only by phenomenological observations assume that the function of the sinus is to protect the brain by slowing blood flow and reducing pulsatility2. Yet another hypothesis interprets the sinus as an ontogenetic or phylogenic residual3. More recently, carotid hemodynamics has been investigated using in vitro and computational models. Flow patterns in the carotid sinus were found to be complex and as such have been implicated in the hetrogenesis and subsequent development of atherosclerosis at this site. However, the development of this unique sinus morphology, the role of hemodynamics in such development, and the physiological implications created by this unique morphology have not been investigated. Understanding the hemodynamic and developmental forces that play a role in remodeling of the carotid bifurcation and development of the sinus is of both fundamental and clinical interest and can lead to better prognostication and therapy of carotid disease.

Therefore, we initiated a study of the morphological development of the human carotid bulb using different age groups under the hypothesis that sinus morphology reflects an adaptive change in response to alterations in cerebral blood supply during the developmental years of the brain. This adaptation attempts to reduce hydraulic losses in the carotid bifurcation through reduced flow disturbances and maintain high level of blood supply to the brain than consumes about 15% of cardiac output under basal conditions. In addition, it may protect the sinus wall from high shear stress and/or the brain from highly pulsatile blood flow conditions.

Initially, we analyzed the angle and sinus morphology of the carotid bifurcation in pediatric and adult patients using biplane digital subtraction angiograms to characterize changes that occur as the brain matures.

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