When anatomy becomes pathology: Rethinking carotid-hyoid contact in cerebrovascular events

In this letter, we comment on the recent article by Karangeli et al, which systematically examined the spatial relationship between the hyoid bone and the carotid arteries using computed tomography angiography. The authors revealed significant anatomical variability in the 224 patients in their study, with type VI (external carotid artery lateral to the hyoid) and type VIII (both carotid arteries lateral to the hyoid) being the most common non-null configurations. Notably, sex-based differences were identified, suggesting possible morphometric or biomechanical influences. These findings have important implications for radiologists and surgeons, as non-null variants - particularly types VIII and XI - might predispose to dynamic carotid compression, transient ischemic events, or intraoperative vascular injury. Recognizing these patterns during preoperative imaging can enhance surgical safety and improve the diagnostic evaluation of unexplained cerebrovascular symptoms. The study by Karangeli et al underscores the clinical importance of translating detailed anatomical mapping into preventive strategies that bridge imaging precision and vascular protection.