Revascularization of the Internal Carotid Artery for Isolated, Stenotic, and Symptomatic Kinking

Abstract

The operation for isolated, stenotic, and symptomatic kinking of the internal carotid artery is safe and effective in preventing stroke and relieving the symptoms of cerebral ischemia. Design: A consecutive sample clinical study with a mean follow-up of 44 months. Setting: The surgical department of an academic tertiary care center and an affiliated secondary care center. Patients: Fifty-four patients with a mean age of 67 years underwent 55 revascularizations of the internal carotid artery. The surgical procedures consisted of the following: shortening and reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases, and transposition into the external carotid artery in 4 cases. Main Outcome Measures: Cumulative survival, primary patency, and stroke-free and neurologic symptomfree rates expressed by standard life-table analysis. Results: No patients died in the postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89% (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%); neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%). Conclusion: Revascularization of the internal carotid artery for the treatment of isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke and relieving symptoms of cerebrovascular insufficiency.

Nonlinear buckling of blood vessels: A theoretical study

“…In contrast, increasing the axial stretch ratio would increase the buckling pressure of the arteries. This conclusion is supported by the clinical observation that while the redundant arteries and vein grafts lead to tortuosity and kinking, surgically shortening the redundancy would eliminate tortuosity and kinking and reestablish artery stability (Zanetti et al, 1997;Fearn and McCollum, 1998;Han et al, 1998;Dobrin et al, 2001;Illuminati et al, 2003;Aleksic et al, 2004;Ballotta et al, 2005). Furthermore, artery buckling alters the wall stress distribution in the arteries and thus affects the cellular function and causes an uneven matrix remodeling (Stein et al, 1994;Vorp et al, 1999) which in the long run may lead to abnormalities in the arteries.…”

Twisted Blood Vessels: Symptoms, Etiology and Biomechanical Mechanisms

“…Severely tortuous or kinking carotid arteries have often been treated by surgical shortening reconstruction [9,113,114]. The surgical ‘stripping’ technique has been used [115].…”

Management of atherosclerotic carotid artery disease: Clinical practice guidelines of the Society for Vascular Surgery

“…12 Carotid endarterectomy for nonhemispheric symptoms, vertebrobasilar symptoms, acute stroke, or for stroke or TIA with internal carotid occlusion is not supported by high quality evidence but rather by very low quality evidence (case series and unsystematic observations). [14][15][16][17] In these settings, and faced with paucity of evidence, surgeon's complication rate and patient's values and preferences play a major role in decision making.…”