Pathological tortuosity of extracranial arteries: a problem long known, but not yet solve

• Sokurenko G.Yu.
• Andreychuk K.A.
• Svetlikov A.V.

Abstract

This article describes the historical data concerning elongated and tortuous brachiocephalic arteries, the first diagnostic methods for confirming tortuosity of carotid arteries, and analyzes the modern approach to the treatment of pathological tortuosity, particularly that of the internal carotid artery. A critical interpretation of the very term “pathological tortuosity” (PT) is given, with the classification and causes of the disease also touched upon. A number of sporadic publications putting forward rather controversial theories of the mechanisms of the development of pathological tortuosity are questioned. Enumerated are the indications for surgery for PT, that correspond to the National Clinical Guidelines. They reflect inconsistency of approaches in the treatment of pathological tortuosity of internal carotid arteries. The main thesis of the authors is that tortuosity of internal carotid arteries, undoubtedly being a common phenomenon, nevertheless requires active surgical tactics only in a very limited number of patients with symptoms of cerebrovascular insufficiency.

Keywords:pathological tortuosity of extracranial arteries; acute cerebrovascular stroke; internal carotid artery; kinking; coiling

References

1. Morgagni G.B. De sedibus et causis morborum per anatomen indagates: Libri quinque. Venice: Typographia Remondiniana. 1767; 502.

2. Kelly A.B. Large Pulsating Vessels in the Pharynx. Glasgow Medical Journal. 1898; 49 (1): 28–32.

3. Edington G.H. Tortuosity of Both Internal Carotid Arteries. British Medical Journal. 1901; 2 (2134): 1526–1527. DOI: https://doi.org/10.1136/bmj.2.2134.1526

4. Rowlands R.P., Swan R.H.J. Tortuosity of Both Internal Carotid Arteries. British Medical Journal. 1902; 1 (2141): 76. DOI: https://doi.org/10.1136/bmj.1.2141.76

5. Moniz E. L’encéphalographie artérielle, son importance dans la localisation des tumeurs cérébrales. Revue Neurologique. 1927; 2: 72–90

6. Moniz E., Pinto A., Alve A. Artériographie du cervelet et des autres organes de la fosse postérieure. Bulletin de l’Académie Nationale de Médecine. 1933; 109: 758–760.

7. Riser M., Geraud J., Ducoudray J., et al. Dolichocarotide interne avec syndrome vertigineux. Revue Neurologique. 1951; 85 (2): 145–151.

8. Vereshchagin N.V., Koltover L.N. On the morphology and pathogenesis of tortuosity and kinks of the internal carotid and vertebral arteries. Pathology Archive. 1966; 12: 11–16. (in Russian)

9. Schmidt E.V., Vereshchagin N.V., Koltover A.N., Bragina L.K. The role of pathological tortuosity of the carotid and vertebral arteries in violation of cerebral circulation. Journal of Neuropathology and Psychiatry. 1962; 1: 15–23. (in Russian)

10. Weibel J., Fields W.S. Tortuosity, coiling, and kinking of the internal carotid artery. Relationship of morphological variation to cerebrovascular insufficiency. Neurology. 1965; 15: 462–468. DOI: https://doi.org/10.1212/wnl.15.5.462

11. Perdue G.D., Barreca J.P., Smith R.B. 3rd, King O.W. The significance of elongation and angulation of the carotid artery: a negative view. Surgery. 1975; 77 (1): 45–52.

12. Metz H., Murray-Leslie R.M., Bannister R.G., et al. Kinking of the internal carotid artery. Lancet. 1961; 1 (7174): 424–426. DOI: https://doi.org/10.1016/s0140-6736(61)90004-6

13. Shifrin E.G., Barkauskas E.M., Pauliukas P.A., et al. Clinical relevance of redundant carotid and vertebral arteries. In: Cerebral revascularization. Eds. Bernstein E., Callow A., Nicolaides A., Shifrin E.G. London: Med-Orion. 1993; 379.

14. Koskas F., Bahnini A., Walden R., Kieffer E. Stenotic coiling and kinking of the internal carotid artery. Annals of Vascular Surgery. 1993; 7 (6): 530–40. DOI: https://doi.org/10.1007/BF02000147

15. Mumoli N., Cei M. Asymptomatic carotid kicking. Circulation. 2008; 72 (4): 682–683.

16. Illuminati G., Calió F.G., Papaspyropoulos V., et al. Revascularization of the Internal Carotid Artery for Isolated, Stenotic, and Symptomatic Kinking. Archives of Surgery. 2003; 138 (2): 192–197. DOI: https://doi.org/10.1001/archsurg.138.2.192

17. Beloyartsev D.F. Surgical treatment of pathological tortuosity of internal carotid arteries: textbook. M.: GBOU DPO RMAPO. 2013; 46. (in Russian)

18. Paulyukas P.A., Barkauskas E.M. Surgery of carotid arteries. Surgery. 1990; 8: 90–94. (in Russian)

19. Macchi C., Gulisano M., Giannelli F., et al. Kinking of the human ICA: a statistical study in 100 healthy subjects by echocolor Doppler. Journal of Cardiovascular Surgery. 1997; 38 (6): 629–637.

20. Kulikov V.P., Khorev N.G., Gerasimenko I.N. et al. Color duplex scanning of vessels in the diagnosis of pathological tortuosity of the carotid arteries. Echography. 2000; 1 (2): 147–154. (in Russian)

21. Hsu I., Kisten A.D. Buckling of the Great Vessels. Archives of Internal Medicine. 1956; 98: 712.

22. Mukherjee D., Inahara T. Management of the tortuous internal carotid artery. American Journal of Surgery. 1985; 149: 651–655.

23. Gavrilenko A.V. Kochetkov V.A., Kuklin A.V., Abramyan A.V. Surgical treatment of patients with pathological tortuosity of the internal carotid artery. Surgery. 2013; 6: 88–91. (in Russian)

24. Togay–Işikay C., Kim J., Betterman K., et al. Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity? Acta Neurologica Belgica. 2005; 105 (2): 68–72.

25. Zhulev N.M., Yakovlev N.A., Kandyba D.V., Sokurenko G.Yu. Stroke of extracranial genesis. St. Petersburg: Publishing House SPb MAPO. 2004; 588.

26. Ballotta E., Abbruzzese E., Thiene G., et al. The elongation of the internal carotid artery: early and long-term results of patients having surgery compared with unoperated controls. Annals of Vascular Surgery. 1997; 11 (2): 120–128. DOI: https://doi.org/10.1007/s100169900021

27. Smirnova Yu.V., Almyasheva L.I. Etiology of pathological deformation of internal carotid arteries and pathogenesis of cerebral circulation disorders in this anomaly (literature review). Clinical neurology. 2012; 1: 33–38. (in Russian)

28. Voevoda M.I., Kulikov V.P., Kulikov I.V. et al. Association of Sp4 gene polymorphism with pathological tortuosity of internal carotid arteries. Cardiology. 2009; 49 (7–8): 46–49. (in Russian)

29. Sokurenko G.Y. Surgical treatment of ischemic brain disease. The world of medicine. 1999; 3–4: 7–12. (in Russian)

30. Ghilardi G., De Monti M., Longhi F., et al. Prevalence of carotid kinking in a resident population. Partial results of the OPI (Objective Prevention of Ictus). Minerva Cardioangiologica. 1993; 41 (4): 129–132.

31. Benes V., Mohapl M. Alternative surgery for the kinked internal carotid artery. Acta Neurochirurgica. 2001; 143 (12): 1267–1271. DOI: https://doi.org/10.1007/s007010100023

32. Skvortsova V.I., Evzelman M.A. Ischemic stroke. Eagle: A. Vorobyov Publishing House. 2006; 404. (in Russian)

33. Schmidt E.V. Vascular diseases of the nervous system. M.: Medicine. 1975; 43–63. (in Russian)

34. Vereshchagin N.V. Deformities of the main arteries of the head and their significance in the development of cerebral circulation disorders in old age. Bulletin of the USSR Academy of Medical Sciences. 1980; 12: 7–10. (in Russian)

35. Stehbens W.E., Fee C.J. Hydrodynamic flow in U-shaped and coiled glass loops simulating carotid arterial configurations. Angiology. 1985; 36 (7): 442–451. DOI: https://doi.org/10.1177/000331978503600706

36. Małek A.K., Hilgertner L., Szostek M. The effect of internal carotid artery elongation on intracranial blood flow. European Journal of Vascular and Endovascular Surgery. 1994; 8 (6): 677–681. DOI: https://doi.org/10.1016/s0950-821x(05)80646-2

37. Beigelman R., Izaguirre A., Robles M., et al. Kinking of carotid arteries is not a mechanism of cerebral ischemia: a functional evaluation by Doppler echography. International Angiology. 2011; 30 (4): 342–348.

38. Pokrovsky A.V. Diseases of the aorta and its branches. M.: Meditsina. 1979; 328. (in Russian)

39. Klinicheskaya angiologiya: Rukovodstvo. Tom 1. Pod red. A.V. Pokrovskogo. M.: Meditsina. 2004; 808. (in Russian)

40. Pokrovsky A.V., Gashtov A.H. Preventive operations on brachiocephalic vessels in vascular cerebral insufficiency of the brain. Journal of Neuropathology and Psychiatry. 1976; LXXVI: 16–23. (in Russian)

41. Pokrovsky A.V., Beloyartsev D.F., Mitina I.E., Adyrkhaev Z.A. When is it necessary to operate on a pathological deformation of the internal carotid artery? Angiology and Vascular Surgery. 2010; 16 (4): 116–122. (in Russian)

42. Pokrovsky A.V., Beloyartsev D.F., Mitina I.E., Adyrkhaev Z.A. Clinical manifestations and diagnosis of pathological deformation of the internal carotid artery. Angiology and Vascular Surgery. 2011; 17 (3): 7–18. (in Russian)

43. Mitina I.E., Burtseva E.A., Losik I.A. Modern approach to complex ultrasound examination of patients with pathological deformation of the internal carotid artery. Angiology and Vascular Surgery. 2011; 17 (3): 49–57. (in Russian)

44. Pokrovsky A.V., Beloyartsev D.F., Adyrkhaev Z.A. Immediate results of reconstructive operations in pathological deformation of the internal carotid artery. Angiology and Vascular Surgery. 2011; 17 (4): 91–98. (in Russian)

45. Pokrovsky A.V., Beloyartsev D.F., Adyrkhaev Z.A. and others. Long-term results of reconstructive operations in pathological deformation of the internal carotid artery. Angiology and Vascular Surgery. 2012; 18 (1): 92–104. (in Russian)

46. Kazanchyan P.O., Valikov E.A. Pathological deformations of internal carotid and vertebral arteries. M.: MEI. 2005; 136. (in Russian)

47. Naylor A.R., Ricco J.B., de Borst G.J., et al. Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018; 55 (1): 3–81. DOI: https://doi.org/10.1016/j.ejvs.2017.06.021

48. Pokrovsky A.V. “Eversion” carotid endarterectomy. Angiology and Vascular surgery. 2001; 7 (2): 105–106. (in Russian)

49. National guidelines for the management of patients with brachiocephalic artery diseases. Moscow, 2013; 70. (in Russian)

50. Sokurenko G.Yu., Andreychuk K.A., Kryzhanovsky D.V., Gorbunov G.N. Pathological tortuosity of extracranial arteries: paradigm shift from general fascination to thoughtful analysis. In the book: Vascular surgery in Russia: present, past and future. Edited by A.S. Revishvili, A.V. Chupin. M.: Offset printing factory. 2020; 146–158. (in Russian)