(1) Background: Twisted carotid bifurcations (CBs) lead to lateralized external carotid arteries (ECAs). Such variants are usually reported on a case-by-case basis. We aimed to study the anatomical possibilities of the axial spin of CB. (2) Methods: Determinations were made bilaterally on a retrospectively assessed sample of 150 cases, 88 males and 62 females. The following types of the axial spin of the CB were determined: type CK1–CB in the coronal plane, with ICA lateral of ECA; type CK3–CB in the coronal plane, with ECA lateral of ICA; the oblique type OK1, with the ECA antero-medial of ICA; the oblique type OK3a, with the ICA antero-medially; the oblique type OK3b, with the ICA postero-laterally; the sagittal type SK2a, with ECA anterior of ICA. (3) Results: In the overall group of 300 CBs, type OK1 was found in 40%, type OK3a in 1%, type OK3b in 2%, type CK1 in 9%, type CK3 in 5.67%, and type SK2a in 42.33% of the bilateral BC group. The types SK2a (46.67%) and OK1 (33.33%) prevailed on the right side. The types OK1 (46.67%) and SK2a (38%) prevailed on the left side. There was no statistically significant association between gender and left or right subtypes. A very strong symmetry existed between the left and right sides (Pearson Chi2 = 53.93 p < 0.001) for types OK1 and SK2a. Asymmetrical types were found in different bilateral combinations. (4) Conclusions: The spin of the CB is relatively symmetrical bilaterally, especially for the variants with the ECA antero-medial or anterior to ICA.