Abstract
Between January 1979 and December 1991, 174 of a total of 2304 carotid reconstructions (7.5%) were performed in 166 patients for stenotic coiling or kinking of the internal carotid artery. There was a 1.4 male predominance and the mean age of the patients was 66.3 ± 9.6 years (range 38 to 91 years). Seventeen patients (9.8%) were asymptomatic, 54 (31%) were symptomatic because of a previous stroke, and 103 (59.2%) had had transient ischemic attacks. The symptoms were hemispheric in 108 (62.1%) cases, ocular in 19 (10.9%), and vertebrobasilar in 30 (17.2%). The stenotic coiling or kinking was isolated in 35 (20.1%) cases and associated with other lesions of the internal carotid artery in 139 (79.9%). These included 119 atherosclerotic stenoses, 14 aneurysms, and six stenotic lesions due to fibromuscular dysplasia. Angioplasty of the carotid bifurcation was performed in 102 (58.6%) patients, associated with endarterectomy in 84 (48.3%) cases and with dilatation of dysplastic lesions in six (3.5%) cases. A bypass graft and resection and anastomosis of the carotid artery were performed in 36 (20.7%) patients each. There were four postoperative deaths (2.3%): two were due to neurologic causes, one to heart disease, and one to complications of an associated surgical procedure. Five patients (2.9%) had postoperative strokes and eight (4.6%) had transient ischemic attacks. At postoperative follow-up investigations four (2.3%) patients had carotid occlusions and 10 (5.7%) had morphologic abnormalities. At 5 years, actuarial survival was 80.97 ± 8.8%, patency was 96.12 ± 2.95%, and the ipsilateral stroke-free rate was 93.12 ± 4.49%. Treatment of stenotic coiling or kinking of the internal carotid artery yields satisfactory results, comparable to those of endarterectomy, for isolated atherosclerotic carotid stenoses and is effective in the prevention of ipsilateral ischemic stroke.
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References
Bauer R, Sheehan S, Meyer JS. Arteriographic study of cerebrovascular disease. Arch Neurol 1961;4:119–126.
Busuttil RW, Memsic L, Thomas DS. Coiling and kinking of the carotid artery. In Rutherford RB, ed. Vascular Surgery. Philadelphia: Saunders, 1989, pp 1406–1411.
Desai B, Toole JF. Kinks, coils and carotids: A review. Stroke 1975;6:649–653.
McKenzie W, Woolf CI. Carotid abnormalities and adenoid surgery. J Laryngol Otol 1959;73:596–598.
Patel KR, Clauss RH. Carotid artery coils and kinks. In Ernst CB, Stanley JC, eds. Current Therapy in Vascular Surgery. Philadelphia: BC Decker, 1991, pp 159–165.
Perdue GD, Barreca JP, Smith RB III, et al. The significance of elongation and angulation of the carotid arteries: A negative view. Surgery 1975;77:45–52.
Quattelbaum JK Jr, Upson ET, Neville RL. Strokes associated with elongation and kinking of the internal carotid artery. Ann Surg 1959;150:824–832.
Quattlebaum JK Jr, Wade JS, Whiddon CM. Stroke associated with elongation and kinking of the carotid artery: Long term follow-up. Ann Surg 1973;177:572–579.
Vannix RS, Joergenson FJ, Carter R. Kinking of the internal carotid artery: Clinical significance and surgical management. Am J Surg 1977;134:82–89.
Weibel J, Fields WS. Tortuosity, kinking and coiling of the internal carotid artery. Neurology 1965;15:7–11.
Najafi H, Javid H, Dye WS. Kinked internal carotid artery. Arch Surg 1964;89:135–146.
Fisher RG. Strokes in children: Their relationship to intrinsic pathology of the carotid artery. Am Surg 1982;48:344–350.
Sarkari NB, Holmes JM, Bickerstaff ER. Neurological manifestations associated with internal carotid loops and kinks in children. J Neurol Neurosurg Psychiatry 1970;33:194–200.
Schechter DC. Dolichocarotid syndrome: Cerebral ischemia related to cervical carotid artery redundancy with kinking. NY State J Med 1979;79:1391–1397.
Cairney J. Tortuosity of the cervical segment of the internal carotid artery. J Anat 1924;59:87–89.
Fisher AGT. Sigmoid tortuosity of the internal carotid artery and its relation to tonsil and pharynx. Lancet 1915;2:128–131.
Jackson JL. Tortuosity of the internal carotid artery and its relation to tonsillectomy. Can Med Assoc J 1933;29:475–478.
Riser MM, Geraud J, Ducoudray J. Dolichocarotide interne avec syndrome vertigineux. Rev Neurol 1951;85:10–12.
Hsu I, Kistin AD. Buckling of the great vessels. Arch Intern Med 1956;98:712–716.
Derrick JR, Kirksley TD, Estess M, et al. Kinking of the carotid arteries: Clinical considerations. Am Surg 1966;32:503–506.
Leipzig TJ, Dohrmann GJ. The tortuous or kinked carotid artery: Pathogenesis and clinical considerations. Surg Neurol 1986;25:478–486.
Metz H, Murray-Leslie RM, Bannister RG, et al. Kinking of the internal carotid artery in relation to cerebrovascular disease. Lancet 1961;1:424–426.
Henly WS, Cooley DA, Gordon WB, et al. Tortuosity of the internal carotid artery: Report of seven cases treated surgically. Postgrad Med 1962;31:133–142.
Stanton PE Jr, McClusky DA Jr, Lamis PA. Hemodynamic assessment and surgical correction of kinking of the internal carotid artery. Surgery 1978;84:793–802.
Bahnini A, Koskas F, Kieffer E, et al. Chirurgie de la carotide interne dans les accidents ischemiques transitoires et les accidents vasculaires cérébraux mineurs homolatéraux. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 179–192.
Kieffer E, Koskas F, Bahnini A, et al. Résultats cliniques tardifs de la chirurgie carotidienne. In Kieffer E, Bousser MG, eds. Indications et Résultats de la Chirurgie Carotidienne. Paris: AERCV, 1988, pp 51–66.
Moore WS, Mohr JP, Najafi H, et al. Carotid endarterectomy: Practice guidelines. Report of the Ad Hoc Committee to the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. J Vasc Surg 1992;15:469–479.
ECST Collaborative group. MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 1991;2:711–720.
NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.
Eikelboom BC, Lawson JA, Moll FL, et al. The hemodynamic significance of carotid coiling. J Cardiovasc Surg 1988;29:437–440.
Lazorthes G, Gouazé A, Thalamon G. Vascularisation et Circulation de l'Encéphale. Tome I. Paris: Masson, 1976, pp. 31–99.
Greenhill NS, Stehbens WE. Haemodynamically induced intimal tears in experimental ushaped arterial loops as seen by scanning electron microscopy. Br J Exp Pathol 1985;66:577–584.
Berguer R, Kieffer E. Surgery of the Arteries of the Head. New York: Springer Verlag, 1992, pp 122–128.
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Koskas, F., Bahnini, A., Walden, R. et al. Stenotic coiling and kinking of the internal carotid artery. Annals of Vascular Surgery 7, 530–540 (1993). https://doi.org/10.1007/BF02000147
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DOI: https://doi.org/10.1007/BF02000147