Lymph node compression causes stenotic kinking of the internal carotid artery

Abstract

A 34-year-old woman presented with recurrent transient ischemic attack (TIA) of the left hemiparesis. Carotid angiography disclosed a stenotic kinking of the right internal carotid artery (ICA). The patient underwent exploration of the right ICA for a planned endarterectomy. An enlarged lymph node was found to have compressed and kinked the artery. The lymph node was removed, and segmental resection of the kinked, stenosed, and atrophic ICA, followed by end-to-end reanastomosis, was performed with successful result. Histologically, the lymph node was calcified, and the atrophy of the ICA, the lumen of which was smooth without atheroma, was localized at the site of compression. Based on the findings of the stenotic kinking of the ICA, long-standing compression by the lymph node was the most probable cause of the kinking, rather than the atherosclerotic change of the ICA.