Comparative analysis of the outcomes of surgical and conservative treatment of patients with pathological kinking of carotid arteries

Gavrilenko A.V., Abramyan A.V., Kouklin A.V.

Department of Vascular Surgery B.V. Petrovsky Russian Research Centre of Surgery under the Russian Academy of Medical Sciences, Moscow, Russia

Objective. The study was aimed at comparatively analyzing the results of surgical and conservative treatment of patients with pathological kinking of carotid arteries in order to determine the indications for operative treatment of patients presenting with the pathology concerned.

Patients and methods. Analyzed herein are the outcomes of managing a total of 75 patients presenting with pathological kinking of the internal carotid artery. Of these, 43 (57,4%) patients were operated on, with a total of 48 interventions performed. A further 32 (42,6%) patients underwent conservative treatment. In the group of operated patients (Group I), an asymptomatic course of pathological tortuosity was encountered in 19 (44,2%) patients, and 24 (35,8%) patients were found to have various-degree cerebrovascular insufficiency. The group of non-operated patients (Group II) consisted of 15 (46,8%) asymptomatic and 17 (53,2%) symptomatic patients. Also discussed are variants of reconstruction of the deformed carotid arteries.

Results. The immediate outcomes were studied within the terms of 30 days. Positive dynamics of the neurological status was observed in both groups. In Group One, 38 (88,3%) patients (p<0,05) of the 43 followed-up patients became symptom-free, and in Group Two, out of the 32 patients, twenty-four (75%) were found to have an asymptomatic course. However, in the remote period (the follow-up term varying from 12 months, 3 and 5 years), positive dynamics of the neurological status was observed in 33 (80,4%) of 41 patients within the follow-up terms up to 5 years), whereas in the Group of non-operated patients it was seen only in 11 (42,3%) of 26 patients (within the follow-up terms up to 5 years) (p<0,05).

Conclusion. Surgical management of patients for pathological kinking of the internal carotid artery is an effective method of preventing progression of cerebrovascular insufficiency in the carotid basin in initially asymptomatic and symptomatic patients, which has been confirmed by the obtained short- and long-term outcomes of the operations in patients with the pathology concerned.

KEY WORDS: pathological kinking, pathological deformity, internal carotid artery, outcomes of treatment.

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