Carotid artery tortuosity

Kinking and coiling of the internal carotid artery is a condition of congenital or acquired origin. It refers to the tortuous shape that the internal carotid artery adopts in the extracranial portion ^1,2.

Clinical presentation

It occurs mainly with neurological disorders ³.

• Dizzinessdizziness
• Lipothymialipothymia
• Earear Buzz
• Syncopesyncope
• Paraesthesiaparaesthesia

Pathology

In acquired cases, the main factors are atheromatous disease, high blood pressure, and ageing. In congenital cases, it has been attributed to a failure in the development process of the third aortic arch and the dorsal aorta in the embryonic period ³.

Classification

They can be classified into 3 different types ⁴.

• Typetype 1: Artery with a non-rectilinear section and an angle greater than 90º.
• Typetype 2: Artery with a section in the form of a curl that generates an angle of 360º about its transverse axis.
• Typetype 3: Twist from the bending of 2 or more segments of an artery with an internal angle of 90.º

Radiographic features

Ultrasound

• Morphologicalmorphological features in grayscale.
• Haemodynamichaemodynamic values in spectral Doppler.

CT angiography

It allows us to performperforming a 3D reconstruction and a precise assessment of the degree of tortuosity of the artery.

Angiography

It allows us to characterisecharacterising the type of tortuosity and has a high sensitivity to detect it.

Treatment

• Arterialarterial transposition is criticised for not removing arterial elongation.
• Vascularvascular procedures such as segmental resection and end to end anastomosis.
• Endarterectomyendarterectomy technique with eversion, which allows correction of severe elongation and kinking of the ICA⁵.