Stenotic Coiling and Kinking of the Internal Carotid Artery

Koskas, Fabien; Bahnini, Amine; Walden, Raphael; Kieffer, Édouard

doi:10.1007/bf02000147

Cited by 69 publications

(61 citation statements)

References 15 publications

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“…Mukherjee and Inahar suggested a possible relationship between kinking and hypertension or TIA, while other authors believe athermanous plaques to be fundamental elements involved in the onset of ischemic stroke in patients suffering from carotid kinking 3,5,21) . Other studies have argued that DCs predispose patients to plaque formation 12,22) .…”

Section: Resultsmentioning

confidence: 99%

“…Anatomical variations of the internal carotid artery (ICA) (i.e., dolichocarotids (DCs)) represent a rare carotid imaging investigation finding, occurring in 2-6% of patients [1][2][3] . Angiographic studies have identified three different types of these abnormalities, defined by Weibel and Fields as follows: "kinking, the most frequent morphological subtype, characterized by ICA angulation ＜90°; tortuosity, with an S-or C-shaped stretch and an angulation ＞90°; coiling, characterized by an elongated carotid tract forming…”

Section: Introductionmentioning

confidence: 99%

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Dolichocarotids: Echo-Color Doppler Evaluation and Clinical Role

Ciccone

Sharma

Scicchitano

et al. 2014

JAT

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dolichocarotids: Echo-Color Doppler Evaluation and Clinical Role

Ciccone

Sharma

Scicchitano

et al. 2014

JAT

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“…(9,27) In both instances the resulting clinical presentation may be transient ischaemic attacks (TIA) and/or completed stroke, usually a minor one, (9,27), probably due to the hemodynamic changes (i.e., the flow within the kinked vessel is not laminar but turbulent) and/or thromboembolic mechanisms including flow changes due to mechanical occlusion associated with changes in head position, microembolization and flow stasis at the kink level. (28,29) In the Koskas et al (9) series of 166 adult patients, predominantly strokes and TIA were observed. In the anecdotal reports on the haemodynamic significance of congenital kinking of the ICA in children, hemiparesis, loss of vision, aphasia and seizures have been described.…”

Section: Clinical and Histopathologic Featuresmentioning

confidence: 99%

Clinical implications of internal carotid artery tortuosity, kinking and coiling: a systematic review

Zenteno¹,

Zavaleta²,

Lee³

2014

Romanian Neurosurgery

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Anatomical variations of the internal carotid artery are diverse. Abnormalities in their geometry and paths are commonly identified by ultrasonography and angiography. The surgical correction of symptomatic CAs is better in preventing stroke compared with best medical therapy, as well as it completely eliminates the symptoms in patients with nonhemispheric symptoms.The ICA anomalies may be dangerous and represent a risk factor for massive bleeding. Suture ligatures can penetrate and occlude torn vessels, scalpels or biting instruments can lacerate vessels, and indirectly conducted electric cauterization can burn the soft of bony tissues.

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“…Enrolled subjects were receiving a stable dose of statin for at least 3 months. We excluded patients with baseline LDL-C above 100 mg/dL to prevent possible consequences of statins withdrawal [17][18][19][20], those with uncontrolled metabolic disorders, genetic dyslipidemias, class III/IV heart failure [21], and with intolerance to the study drugs. Prior statin was discontinued for a week in the screening visit, when they were scheduled to baseline visit under use of aspirin 100 mg daily.…”

mentioning

confidence: 99%

“…OK. USA). Approximately 23% of NIDCM patients were affected by DCs at ECD evaluation, a percentage higher than general population (2-6% [19][20][21]). DCs were six fold more frequent in NIDCM patients than IDCM; furthermore, IDCM revealed a DCs prevalence similar to general population one.…”

mentioning

confidence: 99%