Elastic Tissue Dysplasia of the Internal Carotid Artery

Abstract

Elongation with kinking of the internal carotid artery is not an uncommon finding. Cerebral vascular insufficiency has been reported secondary to this abnormality. Although arteriosclerosis is a frequent cause in adults, the etiology in children has never been explained. Three children with significant kinking of the internal carotid artery are reported here. Each underwent surgical correction by excision and reconstruction. Histological review showed the elastic tissue to be disrupted, diminished in amount, and unevenly distributed. Retrospective examination of this elastic tissue dysplasia showed it to be localized, there being normal morphology both proximally and distal to the involved area. There was recurrence of elongation and kinking in one patient due to incomplete excision. Correction was accomplished after re-excision of the involved tissue with a vein graft interposition. From this study, it can be concluded that elongation and kinking of the internal carotid artery in children is secondary to elastic tissue dysplasia. It is imperative that the entire involved area be removed in order to prevent recurrence. The excised specimen should be studied histologically with elastic tissue stains. Such stains cannot be performed as frozen section. Should permanent studies show the margins of resection not to be beyond the dysplastic tissue, careful followup of these children is essential to recognize recurrence.

Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

“…Reduced wall thickness or lumen diameter is associated with a higher prevalence of tortuosity, although there is discrepancy among the clinical reports on the correlation between atherosclerosis and artery tortuosity [63,65]. Arterial degenerative disease is often concomitant with internal carotid artery tortuosity, but is not always associated with it [1,66,67,68]. …”

“…Increased blood flow also leads to tortuous cerebral arteries associated with elastin degradation [34,35]. The fragmentation of elastin has been reported in the artery wall of subjects with artery tortuosity and has been considered a cause of vessel lengthening [66,68,121]. …”

Carotid Artery – Pathology, Plaque Structure – Relationship between Histological Assessment, Color Doppler Ultrasonography and Magnetic Resonance Imaging – Dolichoarteriopathies – Barorreceptors

“…The proximal portion of the internal carotid artery originates from the third aortic arch while the more distal parts originate from the left dorsal aorta. [130] Harrison and Dávalos [130] suggested that development of carotid arteries and of skeletal system might be asynchronous, the different velocity explaining the tortuous path.Ochsner et al [136] proposed that fibromuscular dysplasia occurring during fetal life, located in a sector of the carotid artery, would be responsible for subsequent weakening and kinking of the wall at that level. Contrary to this specific hypothesis, however, is the fact that presence of fibromuscular dysplasia in areas with dolichoarteriopathies is very rare.…”

A comparative analysis of the reconstructive surgery and conservative treatment efficacy in patients with internal carotid artery tortuosity according to neurologic and ophthalmologic status

“…Этиология таких изменений до сих пор окончательно не выяснена. Одни ученые считают, что ангуляции брахицефальных артерий являются результатом врожденных факторов из-за асинхронного развития частей организма в эмбриональном периоде [6][7][8][9]. Другие авторы приводят данные в пользу атеросклеротических и гемодинамических факторов [10,11].…”