Dolichocarotids: Echo-Color Doppler Evaluation and Clinical Role

Abstract

Aims: Dolichocarotids (DCs) represent a rare (2-6%) carotid imaging finding in the general population that may be free of clinical significance or be associated with cerebrovascular events. Their detection is traditionally assigned to carotid echo-color Doppler (ECD) and selective angiography (the standard method). The primary aim of this study was to estimate the sensitivity, specificity and accuracy of ECD in detecting DCs. Moreover, we monitored the DC curvature angle and the incidence of TIA, ischemic stroke, myocardial infarction and cardiovascular death over a five-year followup period. Methods: A total of 112 consecutive patients with DCs (80 men, mean age: 61±7 years) were recruited for carotid ECD and carotid angiography due to the persistence of neurological symptoms not well explained on ultrasound evaluations, according to the current guidelines. Results: ECD proved to have 100% sensitivity in detecting tortuosity and coiling and 96% sensitivity in detecting kinking, with an overall accuracy ranging from 92% to 100%. The specificity was 75% for tortuosity, 91% for kinking and 100% for coiling. During the five-year follow-up period, there was a statistically significant increase in tortuosity (61±11° at baseline versus 81±11° after five years, p＜0.001) and the kinking curvature angle (97±3° at baseline versus 100±3° at five years, p＜0.001), whilst no differences were observed with respect to coiling (136±10° at baseline versus 138±11° at five years, p = ns). Moreover, kinking was found to be more frequently statistically associated with cardiovascular death than tortuosity (p = 0.005). Conclusions: DCs predispose patients to potentially disabling and fatal events. ECD plays a primary role in the detection of DCs and therefore should be considered to be a secure and reproducible technique.

Elevated Total Homocysteine Levels in Acute Ischemic Stroke Are Associated With Long-Term Mortality

“…The clinical role of dolichocarotids is currently unclear, and studies have denied an association between these carotid abnormalities and cerebrovascular events. One study found kinking to be more frequently associated with cardiovascular death than tortuosity, 35 and another study showed that dolichocarotids are associated with dilated cardiomyopathy. 36 However, only a small proportion of patients (2% to 6%) have dolichocarotids and, in our study, we did not consider dolichocarotids as a confounding factor associated with cardiovascular-related mortality.…”

Trajectories of Vasomotor Symptoms and Carotid Intima Media Thickness in the Study of Women’s Health Across the Nation

“…Other conditions relevant to development of atherosclerosis (e.g., chronic obstructive pulmonary disease, autoimmune disorders), were not rigorously assessed. Aspects of vessel morphology linked to CVD risk (i.e., dolichocarotids 30, 31 ) were not systematically assessed and should be considered in future work. Further, IMT was assessed once at visit 12; thus trajectories of IMT could not be characterized.…”

Routine Clinical Evaluation of Cerebrovascular Reserve Capacity Using Carbogen in Patients With Intracranial Stenosis

“…We chose to restrict inclusion criteria to a relatively homogeneous population of asymmetric IC stenosis patients with no cervical stenosis >70%, and we perform multivariate analysis of the major stroke risk factors only (Supplementary Material). We did not control for dolichoectasia, although patients with dolichoectasia and related cerebrovascular morphological abnormalities of cervical vessels may have increased stroke risk 17, 18 . Unfortunately, our patients do not routinely undergo carotid echo-color Doppler and only a subset of our patients had cerebral angiography; larger studies that assess the relationship of CVR with other stroke risk factors may benefit by incorporating separate measurements of dolichoectasia.…”