Stroke Associated with Elongation and Kinking of the Internal Carotid Artery

Quattlebaum, Julian K.; Upson, E. Thomas; Neville, R.L

doi:10.1097/00000658-195911000-00005

Cited by 85 publications

(16 citation statements)

References 5 publications

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“…26 From then until now, the available reports describe relief of neurologic symptoms by revascularization of a kinked carotid artery. 3,6,9,10,[15][16][17][18][19][20][21][22] The rationale behind revascularization of the ICA for symptomatic kinking is to relieve symptoms, prevent carotid thrombosis and stroke, and improve cerebral perfusion. However, the relationship between kinking of the ICA and cerebrovascular insufficiency and, thus, the indication for surgical treatment have been sometimes questioned, particularly when nonhemispheric symptoms are involved.…”

Section: Commentmentioning

confidence: 99%

“…1 This condition is detected in about 5% to 25% of the arteriograms of cervical arteries performed for cerebrovascular symptoms or for the further definition of an incidentally encountered, asymptomatic carotid artery stenosis. [2][3][4][5][6][7][8][9][10] In adult patients with symptoms of cerebrovascular insufficiency, kinking of the ICA is often associated with significant atheroma of carotid bifurcation. Carotid endarterectomy has proven effective for the treatment of stenotic and symptomatic plaques.…”

mentioning

confidence: 99%

“…8,14 Other reports, based on the belief that ICA kinking is a potentially harmful condition, indicated its treatment to be surgical and reported good results with revascularization of the ICA. 3,6,9,[15][16][17][18][19][20][21][22] In patients with proven clinical cerebrovascular insufficiency associated with a stenotic kinking of the ICA, when any other cause of symptoms can be eliminated, surgical correction of the kinking would be likely to allow relief of symptoms and protection against ipsilateral cerebral ischemia. In this study, we systematically performed surgical revascularization in patients with isolated, stenotic, and symptomatic kinking of the ICA, and analyzed the outcome to determine whether such a hypothesis could be deemed correct.…”

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confidence: 99%

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

Caliò¹,

Papaspyropoulos²,

Montesano³

et al. 2003

Arch Surg

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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.

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Section: Commentmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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

Caliò¹,

Papaspyropoulos²,

Montesano³

et al. 2003

Arch Surg

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“…One theory maintains that they are pathological alterations caused by arterial aging and/or changes induced by atherosclerotic remodeling, which would cause the vessel to bend, [114,[123][124][125][126] while other reports do not support an association between dolichoarteriopathies and cardiovascular risk status. [122,127,128] Alternatively, it has therefore been postulated that they have an embryological origin.…”

Section: Origin Of Carotid Dolichoarteriopathies -Congenital or Acquimentioning

confidence: 99%

“…Part of the uncertainty derives from the fact that previous observations had been made in small studies or in selected populations. [122][123][124][125][126][127][128] Therefore, it would be important to establish which theory has more solid basis.…”

Section: Origin Of Carotid Dolichoarteriopathies -Congenital or Acquimentioning

confidence: 99%

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

Beigelman¹,

Izaguirre²,

Azzato³

et al. 2014

Carotid Artery Disease - From Bench to Bedside and Beyond

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Regarding the biology of the unstable atherosclerotic carotid plaque, an expression of c-fos, p53 and PCNA was demonstrated by us. [21] On the other hand, MRI has excellent soft tissue contrast and is able to quantify carotid plaque size and composition with good accuracy and reproducibility and provides an opportunity to prospectively examine the relationship between plaque features and subsequent cerebrovascular events. [22] In a paper by Takaya et al [23] 154 patients with an asymptomatic 50% to 79% carotid stenosis by ultrasound with > or =12 months of follow-up were included for multicontrast-weighted carotid MRIs were included. Over a mean follow-up period of 38.2 months, arteries with thinned or ruptured fibrous caps, intraplaque hemorrhage, larger maximum %lipid-rich/necrotic cores, and larger maximum wall thickness were associated with the occurrence of subsequent cerebrovascular events. [23] MRI imaging techniques have permitted serial monitoring of atherosclerotic disease evolution and the identification of intraplaque risk factors for accelerated progresión. [22] At last, based upon our research, carotid barochemoreceptor involvement in old patients who died from stroke and suffering obstructive carotid atheromatosis will be discussed. [24] Carotid Artery Disease-From Bench to Bedside and Beyond 32

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Arteriographic Study of Cerebrovascular Disease

Bauer¹

1961

Arch Neurol

106

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Patient and Doctor-When a doctor supplies his patient with treatment and earns his fee, the transaction does not and never can possess the enviable simplicity of that between tradesman and customer, when in return for the appropriate price a pound of some commodity is handed across the counter. The attitude of the patient approaching his doctor must always be tingedfor the most part unconsciously-with distaste and dread; its deepest desire will tend to be comfort and relief rather than cure, and its faith and expectation will be directed towards some magical exhibition of these boons. Do not let yourselves believe that however smoothly concealed by education, by reason, and by confidential frankness these strong elements may be, they are ever in any circumstances altogether absent.The doctor on his part is perhaps dimly aware of the strange mixture of distrust and inordinate expectation that the patient unconsciously entertains ; he knows, moreover, how feeble are the resources against disease he commands, and he knows that for the reconciliation of these two incompatibles the responsibility will rest on him and his personal moral force.·-Emergency, The Collected Papers of Wilfred Trotter, Oxford and New York, Oxford Univ. Press, 1941, pp. 194.

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Stroke Associated with Elongation and Kinking of the Internal Carotid Artery

Cited by 85 publications

References 5 publications

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

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

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

Arteriographic Study of Cerebrovascular Disease

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