Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Abstract

Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 -Africans: 7 males & 3 females and 4 -East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.

Dolichocarotids: Echo-Color Doppler Evaluation and Clinical Role

“…Nevertheless, kinking is associated with a greater increase in cardiovascular death than is tortuosity. In fact, we found a six-fold increase in this outcome in patients suffering from kinking compared ICA may be the result of an embryonic development failure with anomalous absorption of the third aortic arch or the upper intersegmental artery with subsequent curving, kinking, tortuosity and looping of the ICA 11,19) . More frequently, this disease is linked to vascular structure weakening due to hereditary defects or destruction of the internal elastic layer, such as that due to fibromuscular dysplasia, aging or chronic diseases, such as atherosclerosis and hypertension 9,10,20,21) .…”

Aberrations of the Cervical Carotid Artery Which May Be Dangerous in Pharyngeal Surgery—A Computed Tomographic Study

“…Variations in the anatomical course of the cervical portion of the internal carotid artery (ICA) are frequent and reported to occur in about 6% -30% of patients with some authors even reporting a prevalence as high as 62% (as reviewed by Ovchinnikov et al) [1]. In most cases, these are incidental findings lacking clinical relevance.…”

“…The differentiation of clinical relevant and irrelevant variations is therefore of considerable value, especially as relevant variations are described in as much as 62% of patients [1]. It appears that some elongation or kinking of the cranial portions of the cervical segments of the carotid arteries is a normal compensatory mechanism to prevent overstretching and narrowing during movement of this important blood supply to the brain [1]. Prevalences of anatomic variants recorded in the literature are wide ranging from 5.3% to 62.4% (with n = 1123 [9], and n = 590 [10], respectively).…”

“…On the other hand, these aberrations are an important differential diagnosis in the evaluation of pharyngeal masses such as tumorous entities or abscesses and any recognised variant anatomy may clearly alter patient management [2][3][4][5][6][7][8]. The differentiation of clinical relevant and irrelevant variations is therefore of considerable value, especially as relevant variations are described in as much as 62% of patients [1]. It appears that some elongation or kinking of the cranial portions of the cervical segments of the carotid arteries is a normal compensatory mechanism to prevent overstretching and narrowing during movement of this important blood supply to the brain [1].…”

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

“…(15,16,19) Acquired form of kinking and coiling is most commonly associated with aging, hypertension and traditional risk factors for atherosclerosis, (20)(21)(22) it is characterized by degenerative changes and elastic tissue destruction of the vessel wall, which causes elongation of the vessel and also a bending stress, additionally in each systole there is a momentary elongation may increase the kink. (6) The prevalence of arterial hypertension in patients with kinking appears to be greater than those without this anomaly, Pancera et al studied 590 patients with neurological symptoms by ultrasound (USG) Doppler of neck vessels, and found a prevalence of 28.4% in normotensive and 37.8% in hypertensive patients, with significant difference in both groups (P <0.01).…”