Vol 6, No 4 (2004)
Published online: 2005-01-26
Internal carotid artery kinking — actual incidence, indications for surgical treatment and long-term results based on ultrasound evaluation
Chirurgia Polska 2004;6(4):185-193.
Abstract
Background: Clinical assessment of the consequences of internal carotid artery elongation remains controversial. Nevertheless, the coexistence of neurological symptoms in some of the patients with this pathology inclines some vascular centers to qualify a number of patients for surgical treatment.
The aim of this study was to present our own experience in US diagnosis and treatment of internal carotid artery elongation.
Material and methods: We analyzed the frequency of ICA elongation among patients diagnosed by our Vascular Examination Lab (period between 1998–2002), and consequently presented treatment results of patients qualified for surgery because of symptomatic ICA elongation. In this 5 year period, 76 patients were operated on and during surgery the patients where monitored using near infrared spectroscopy (NIRS), transcranial Doppler (TCD) and neurological assessment. In 73 out of 76 patients reimplantation and ICA dilatation was performed. In the perioperative assessment, changes in the flow in the ICA (Vmax and PS ICA/CCA index changes) were analyzed. In the follow up (> 12 months from surgery) the operated vessels were assessed ultrasonographically for restenosis. The authors paid special attention to the techniques of ultrasound examination and surgery.
Results: The frequency of ICA elongation phenomenon was assessed on the basis of 4903 ultrasound examinations in about 29.6% (1452 patients). 76 patients were deemed qualified for operative treatment. Early results (postoperative complications) as well as long term (hyperplasia and restenosis phenomena) were judged as very good.
Conclusions: Kinkings of ICAs occur more frequently than one may think according to common ultrasound examinations. Because of this during every ultrasound examination of the carotid arteries the entire extracranial section of the ICA (40–50 mm) should be visualized. Surgical treatment should not only be limited to vessel re-implantation, but should also consist of mechanical intravascular dilatation of the artery. The long term results of reimplantation are good and special attention should be drawn to the lack or presence of minimal hyperplasia in the anastomosis after ICA elongation surgery.
The aim of this study was to present our own experience in US diagnosis and treatment of internal carotid artery elongation.
Material and methods: We analyzed the frequency of ICA elongation among patients diagnosed by our Vascular Examination Lab (period between 1998–2002), and consequently presented treatment results of patients qualified for surgery because of symptomatic ICA elongation. In this 5 year period, 76 patients were operated on and during surgery the patients where monitored using near infrared spectroscopy (NIRS), transcranial Doppler (TCD) and neurological assessment. In 73 out of 76 patients reimplantation and ICA dilatation was performed. In the perioperative assessment, changes in the flow in the ICA (Vmax and PS ICA/CCA index changes) were analyzed. In the follow up (> 12 months from surgery) the operated vessels were assessed ultrasonographically for restenosis. The authors paid special attention to the techniques of ultrasound examination and surgery.
Results: The frequency of ICA elongation phenomenon was assessed on the basis of 4903 ultrasound examinations in about 29.6% (1452 patients). 76 patients were deemed qualified for operative treatment. Early results (postoperative complications) as well as long term (hyperplasia and restenosis phenomena) were judged as very good.
Conclusions: Kinkings of ICAs occur more frequently than one may think according to common ultrasound examinations. Because of this during every ultrasound examination of the carotid arteries the entire extracranial section of the ICA (40–50 mm) should be visualized. Surgical treatment should not only be limited to vessel re-implantation, but should also consist of mechanical intravascular dilatation of the artery. The long term results of reimplantation are good and special attention should be drawn to the lack or presence of minimal hyperplasia in the anastomosis after ICA elongation surgery.
Keywords: internal carotid arterykinkingsurgical treatmentultrasonography
