The Mother of All Carotids A complex carotid intervention in a patient with a bicarotid trunk and anomalous origin of the right subclavian artery.

The anatomy of the aortic arch plays a critical role in determining the appropriate technique to be used for treating patients with atherosclerotic disease of the great vessels. Many variations occur in the number and position of vessels arising from the aortic arch. Approximately 80% of the population has the normal threevessel aortic arch configuration. The most common variation from the usual anatomy is a two-vessel arch, known as the “common origin of the carotid arteries,” in which the left common carotid artery arises from the innominate artery (bovine origin), leaving only two branches originating from the aortic arch. Multiple other variations have been reported, and one of the more uncommon configurations of the three-vessel arch is known as the bicarotid trunk, in which the common carotid arteries arise from a shared trunk and the subclavian arteries arise separately from the aorta. In this case report, we describe a complex carotid intervention in a patient with a bicarotid trunk and anomalous origin of the right subclavian artery.