Surgical treatment of pathological kinking of the internal carotid artery

Dadashov S.A., Lavrentiev A.V., Frolov K.B., Vinogradov O.A., Dzyundzya A.N., Ulyanov N.D.

Department of Vascular Surgery University Clinical Hospital No1, State Educational Facility of Higher Professional Education «First Moscow State Medical University named after I.M. Sechenov» Course of Emergency Surgery at the Surgery Chair of the Faculty of Advanced Medical Training, Moscow, Russia

The study was aimed at improving surgical policy in management of patients presenting with pathological tortuosity of the internal carotid artery.

The study comprised a total of 105 patients with pathological kinking of the internal carotid artery undergoing a total of 117 reconstructive operations. In order to determine the indications for the operation the patients were subjected to triplex scanning, transcranial Dopplerography and monitoring of blood flow in the median cerebral artery, contrast-enhanced computed tomography or magnetic resonance tomography. Depending upon the degree of intimal proliferation in the area of the maximal bend («septal tortuosity»), the patients were divided into two groups: group I – pathological kinking of the internal carotid artery without intimal proliferation – 75 patients, group II – pathological kinking with intimal proliferation – 30 patients.

The indications for the operation were determined depending upon the degree of cerebrovascular insufficiency, haemodynamical significance of pathological tortuosity, the presence of intimal proliferation in the zone of the maximal bend – «septal tortuosity». An operation of choice for Group I patients was resection of the internal carotid artery with redressation and reimplantation into the own bed, and all Group II patients underwent resection of the area of kinking of the internal carotid artery with an end-to-end anastomosis in order to remove the septal portion. Immediately after the operation 85% of patients were found to have their cardiovascular insufficiency symptoms relieved and all patients showed improved haemodynamic parameters (p<0.01). Neither postoperative strokes nor lethal outcomes were registered.

KEY WORDS: pathological kinking of the internal carotid artery, pathological deformity, surgical management.

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