Abstract
PurposeThe etiology of coiling (i.e. severe elongation) of the extracranial part of the internal carotid artery (ICA) is poorly understood with the proposed etiology being congenital, atherosclerotic or hypertension. The objective was to investigate the association of coiling with hypertension, carotid artery atherosclerosis and other cardiovascular risk factors.MethodsA case control study was performed in patients suspected of stroke, with (cases) or without (controls) coiling of the ICA determined on compute tomography angiography (CTA). Baseline characteristics included age, gender, hypertension, diabetes, smoking and hypercholesterolemia. Coiling of the ICA and atherosclerotic plaque at the carotid bifurcation were assessed on CTA. Logistic regression analyses were conducted.ResultsCoiling was identified in 108 patients with a median age of 71 years. Cases were compared with 256 controls with a median age of 69 years. Hypertension was present in 63% of the patients with coiling compared to 51% in the control group. Univariable analysis showed that hypertension was significantly associated with coiling, with an odds ratio of 1.65 (95% confidence interval (CI) 1.04–2.61, p = 0.034). Multivariable analysis corrected for age and sex resulted in an odds ratio of 1.71 (95% CI 1.05–2.80, p = 0.032), while correcting for atherosclerotic plaque at the bifurcation yielded an odds ratio of 1.63 (95% CI 1.00–2.66, p = 0.049). Age and atherosclerotic plaque were not significantly associated with coiling.ConclusionThe main finding of this study was the significant association of hypertension with coiling of the ICA and the absence of an association with age, plaques and atherosclerotic risk factors other than hypertension.
Highlights
Coiling of the internal carotid artery (ICA) is a rare morphologic alteration in the course of the artery
The main finding of this study was the significant association of hypertension with coiling of the ICA and the absence of association with age, plaques and atherosclerotic risk factors other than hypertension
Previous investigators showed an association between hypertension and a combined group of patients with coiling, tortuosity and kinking in smaller studies or imaging techniques that are less reliable than CT [15,16,17]
Summary
Coiling (i.e. severe elongation) of the internal carotid artery (ICA) is a rare morphologic alteration in the course of the artery. Hypertension can lead to arterial vessel lengthening due to an imbalance between forces to the vessel wall [7]. This can result in an increase in the diameter and loss of stiffness of large arterial vessels, resulting in stretching of circumferential smooth muscle cells of the tunica media [8]. Atherosclerotic remodeling could result in coiling of the arteries through hemodynamic abnormalities [9, 10]. The objective of this article is to investigate the association of coiling with hypertension, carotid atherosclerosis and other cardiovascular risk factors
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