Surgical treatment of severe deformity of the internal carotid arteries

Abstract

Objective. To evaluate the outcomes of internal carotid artery (ICA) redressment with transposition into the «new orifice» with a severe pathological elongation of the internal carotid artery. Materials and methods. In 2021, 42 operations were performed in 38 patients having severe deformations of the ICA required the transposition of ICA orifice by 2 or more diameters from the old orifice are presented. Four patients underwent reconstructions on both sides. All patients were symptomatic, with chronic cerebrovascular insufficiency grade 2–4 (according to the classification of A. V. Pokrovsky, 1978). 29 women (76.3 %), 9 men (23.7 %) were enrolled in the study. The average age was 69.1±7.7 years. 18 patients (47.4 %) were found to have a combination of hemodynamically significant pathological deformities with atherosclerotic lesions of the carotid arteries. All patients underwent ultrasound duplex scanning and computed tomography with contrasting brachiocephalic arteries in the preoperative period. Results. Most deformations are represented by S- and Z-shaped (73,8 %) оr ICA loops (21,4 %). The maximum level of transposition was required for loop deformations (25.6 mm±6.17) and was comparable for S- and Z-shaped deformations (17.8 mm±6.3; 17.5 mm±8.0). In the postoperative period, there were no signs of cerebral circulation disorders in this group of patients. In 84 % of cases, 32 patients showed clinical improvement with partial or complete regression of cerebral neurological symptoms. In 1 case (2.4 %), there was a hematoma of a postoperative wound that did not require specific surgical or medical treatment. During postoperative duplex control in the postoperative period, turbulent flows, stenosis and deformity in the area of the new orifice were not observed. Conclusion. The results confirm the data reported by other authors about the safety of the surgical method. ICA reconstruction with orifice transposition may be an alternative method of surgical treatment with minimal risk of complications. To achieve the best result, during the creation of a new orifice of the ICA, it is necessary to preserve as much as possible the original anatomy of the bulb of the ICA and the bifurcation of the common carotid artery. For a more detailed assessment of the results, further study is planned on a large clinical material.