Morphological changes of the internal carotid artery: prevalence and characteristics. A clinical and ultrasonographic study in a series of 19 804 patients over 25 years old

Abstract

Background and purpose: Morphological changes of the internal carotid arteries (McICA) are frequently found during cervical ultrasound studies. However, the etiology of McICA remains controversial. During this study, the prevalence and demographic characteristics of McICA, such as kinking, coiling or looping identified by Doppler ultrasound, were analysed and its relationship with vascular risk factors and stroke was assessed. Methods: A retrospective study was performed by analysing 19 804 patients who were subjected to cervical ultrasonographic study between January 2000 and June 2012. The data were statistically analysed with SPSS Ò 20 and a multivariate logistic regression was performed. Statistical significance was accepted for P < 0.05 and 95% confidence intervals (CIs) were used.Results: Morphological changes of the internal carotid arteries were present in 2678 patients (13.5%) and were unilateral in 61.6% of these cases. Carotid kinking was found in 80% of the patients, coiling in 16% and looping in 1%. In multivariate analysis, the presence of McICA was related to older groups (1.04; 95% CI, 1.04-1.05; P < 0.01), female gender (1.78; 95% CI, 1.64-1.94; P < 0.01), patients with hyperlipidemia (1.28; 95% CI, 1.17-1.40; P < 0.01), carotid thickness (1.22; 95% CI, 1.13-1.33; P < 0.01) and cardiac or cardioembolic disease (1.11; 95% CI, 1.01-1.21; P = 0.02). The results of this study indicate that kinking in the carotid artery was associated with ipsilateral cerebral ischemic events (1.43; 95% CI, 1.040-1.958; P < 0.05). Conclusion: Morphological changes of the internal carotid arteries were associated with aging, female gender and patients with hyperlipidemia, hypertension, diabetes and heart disease. Kinking was associated with ipsilateral cerebral ischemia.

Prevalence of internal carotid artery morphological variations and its association with cerebrovascular ischemic stroke (hospital-based study)

“…Like our results, we found an insignificant higher prevalence rate among females. A more prominent change in vessel wall morphology among females could be linked to hormonal processes especially among postmenopausal women [7]. The tortuosity and kinking were the commonest ICA MV reported by them, and they were more frequently found on the left side which was in concordance to our results.…”

“…Acquired could be due to atheroma, aging, and/or hypertension [6]. The clinical significance of MV in ICA is not well studied; however, a tortious artery may increase the probability of vessel spasm [6], and some authors postulated that MV are associated with a higher risk of IS [7]. However, Radak et al stated that IS accident occurs in about 11-33% of these cases [8].…”

“…However, Radak et al stated that IS accident occurs in about 11-33% of these cases [8]. The prevalence of ICA MV in IS patients ranged from 4 to 66% [7,[9][10][11].…”

A Rare and Subtle Etiology of Chronic Oropharyngeal Pain: Isolated Internal Carotid Artery Kinking without Stenosis

“…3 Even though the pathophysiological mechanism of the morphological changes in the internal carotid artery remains unclear, it is known that carotid kinking has an increased incidence rate in older age group, female gender, and patients with hyperlipidemia, hypertension, diabetes mellitus, and ischemic heart disease. 1 In our case, the patient was female, had a history of diabetes mellitus and hypertension, hence she was in consistency with the presumed risk factors.…”

“…It has an increased incidence rate in older age group, female gender, patients with hyperlipidemia, hypertension, diabetes mellitus, and ischemic heart disease. 1 Despite being a silent disorder in most of the cases, internal carotid artery kinking without significant stenosis may result in hemispheric and nonhemispheric symptoms. There are controversial data on whether morphological changes in internal carotid artery may cause carotid artery stenosis and ischemic stroke.…”