Method of surgical treatment of patients with combined pathological tortuosity of the common and internal carotid arteries

Mikhailov M.S.¹, Ridel V.Y.¹, Musaev A.B.¹, Stadler V.V.²

¹ Department of Vascular Surgery, Samara Municipal Clinical Hospital № 1 named after N.I. Pirogov,
² Department of Anaesthiology, Samara Regional Clinical Oncology Dispensary, Samara, Russia

Pathological tortuosity of the internal carotid artery ranks next to atherosclerosis amongst causes leading to development of ischaemic strokes. In some patients pathological tortuosity of the internal carotid artery is combined with pathological kinking of the common carotid artery. Existing methods of surgical treatment for such concomitant pathology include stegewise elimination of kinking of the internal then common carotid artery, with two anastomoses sequentially formed, thus increasing the overall duration of arterial cross-clamping an prolonging cerebral ischaemia. Another method consists of resection of the common carotid artery with bringing down its bifurcation, restoration of straightness of the internal carotid artery, and formation of an end-to-end anastomosis. The second technique is often associated with technical requirement for ligation of the external carotid artery. In the presence of prolonged atherosclerotic lesions of the bifurcation of the internal and external carotid arteries, this method does not always allow carrying out adequate endarterectomy and fix the intima of the internal carotid artery distal to the bifurcation. The authors developed a method of surgical treatment of patients with a combination of pathological kinking of carotid arteries, providing herein a detailed description of the procedure of performing an operation according to an original technique. The proposed method of reconstruction makes it possible to eliminate pathological kinking of the common and internal carotid arteries in single cross-clamping of vessels, to preserve patency of the external carotid artery and in the presence of an atherosclerotic lesion of the bifurcation to perform adequate endarterectomy.

Over the period from 2015 to 2019, a total of 10 patients were operated on according to this technique at the Municipal Vascular Centre of Samara, with no postoperative complications observed.

The proposed technique of a reconstructive operation may be effectively used in patients with cerebral ischaemia in concomitant pathological kinking of the common and internal carotid arteries.

KEY WORDS: ischaemic stroke, pathological tortuosity, common carotid artery, internal carotid artery, open surgical procedure

Р. 164

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