Carotid artery tortuosity
Citation, DOI & article data
Carotid artery tortuosity is the elongation of the extracranial carotid arteries with redundancy and/or altered course, which may present on imaging as kinking, coiling, and/or looping 1,2.
The pathogenesis of carotid artery tortuosity is unknown 4.
- hypertension 3
- aging 3
- atherosclerosis/atheroma 3
- obesity 4
- connective tissue diseases, e.g. Marfan syndrome, Loeys-Dietz syndrome, neurofibromatosis type 1 4
- congenital: failure in the development process of the third aortic arch and the dorsal aorta in the embryonic period 3
Carotid artery tortuosity can be classified into three different types 4:
- type 1: artery with a non-rectilinear section and an angle >90º
- type 2: artery with a section in the form of a curl that generates an angle of 360º about its transverse axis
- type 3: twist from the bending of ≥2 segments of an artery with an internal angle of 90º
- morphological features in grayscale
- hemodynamic values in spectral Doppler
CT angiography allows for 3D reconstruction and a precise assessment of the degree of tortuosity of the artery.
Angiography allows characterizing the type of tortuosity and has a high sensitivity to detect it.
- arterial transposition is criticized for not removing arterial elongation
- vascular surgery, e.g. segmental resection and end-to-end anastomosis
- endarterectomy technique with eversion, which allows correction of severe elongation and kinking of the ICA 5
- 1. Kis B, Weber W, Berlit P, Kühne D. Elective Treatment of Saccular and Broad-Necked Intracranial Aneurysms Using a Closed-Cell Nitinol Stent (Leo). Neurosurgery. 2006;58(3):443-50. doi:10.1227/01.neu.0000197103.10364.0c - Pubmed
- 2. Beigelman R, Izaguirre A, Robles M, Grana D, Ambrosio G, Milei J. Are Kinking and Coiling of Carotid Artery Congenital or Acquired? Angiology. 2009;61(1):107-12. doi:10.1177/0003319709336417 - Pubmed
- 3. Del Corso L, Moruzzo D, Conte B et al. Tortuosity, Kinking, and Coiling of the Carotid Artery: Expression of Atherosclerosis or Aging? Angiology. 1998;49(5):361-71. doi:10.1177/000331979804900505 - Pubmed
- 4. Welby J, Kim S, Carr C et al. Carotid Artery Tortuosity Is Associated with Connective Tissue Diseases. AJNR Am J Neuroradiol. 2019;40(10):1738-43. doi:10.3174/ajnr.a6218 - Pubmed
- 5. Milic D, Jovanovic M, Zivic S, Jankovic R. Coiling of the Left Common Carotid Artery as a Cause of Transient Ischemic Attacks. J Vasc Surg. 2007;45(2):411-3. doi:10.1016/j.jvs.2006.10.002 - Pubmed