Symptomatic Kinking Research Articles

Surgical Revascularization of Symptomatic Kinking of the Internal Carotid Artery.

To evaluate the safety and outcomes of surgical revascularization for patients with symptomatic kinking of the internal carotid artery (ICA). Twenty-five consecutive patients presented with symptomatic kinking of the ICA and a history of transient ischemic attack (TIA) or stroke were prospectively enrolled in this study. All patients were treated with ICA transection and end-to-side reimplantation at the level of the carotid bulb. Patients were followed up for a median of 32 months. There were no deaths or strokes within the 30 days of the treatment. No postprocedural thrombosis or narrowing of the ipsilateral ICA was observed. One (4%) patient had temporary recurrent nerve palsy, which was completely recovered at 4-week follow-up. One (4%) patient had a myocardial ischemic event. At the end of the 32-month follow-up, 1 (4%) patient developed ipsilateral minor stroke. No recurrent stenosis was detected by Doppler ultrasound. Surgical treatment for isolated, symptomatic kinking of the ICA and a history of TIA or stroke is safe, and the outcomes are acceptable.

Carotid angioplasty and stenting for symptomatic carotid kinking combined with stenosis

Background Carotid endarterectomy (CEA) is currently the preferred treatment for severe carotid kinking and stenosis. Kinking is generally believed to be a relative contraindication for endovascular stent placement. This article aims to study the necessity, feasibility and security of carotid angioplasty and stenting (CAS) for symptomatic carotid kinking combined with stenosis, and summarize clinical experience of this disease according to therapeutic results. Methods Twenty-two cases with symptomatic carotid kinking and high-grade stenosis demonstrated by digital subtraction angiography (DSA) were performed CAS. Their clinical manifestations, imaging features, procedure safety and follow-up data were collected and retrospectively analyzed. All patients understood CEA and voluntarily received CAS. Results Twenty-two cases with carotid kinking and stenosis were all successfully performed CAS (the success rate was 100%) without stent-related disability or mortality. Twenty-four self-expandable stents were implanted. The mean degree of stenosis was reduced from 85.63% before stenting to 11.25% after stenting and the angles of kinking were improved from 120° (Metz' category). During the period of hospitalization, no transient ischemic attack (TIA) or cerebral infarction occurred, and the clinical symptoms and signs of ischemia, such as dizziness and headache, were improved or disappeared. Besides, no permenant complications or deaths happened. All cases were followed up from 6 to 72 months, among whom 1 patient experienced contralateral carotid TIA, and 2 patients experienced ipsilateral carotid TIA (one indicated aspirin resistance in platelet aggregation test and the other showed restenosis in DSA). Computed tomography angiography (CTA) of 10 patients and Duplex scan of 7 patients during the follow-up demonstrated carotid in good morphology and fluent blood flow, without kinking or restenosis. Conclusion CAS is a feasible and safe therapeutic method and maybe helpful to lower the risk of cerebral ischemia for the patients with symptomatic kinking and stenosis. However, further study is still needed.

Endovascular management of symptomatic carotid stenosis combined with kinking

To study the necessity, feasibility, security of carotid angioplasty and stenting (CAS) for symptomatic carotid stenosis combined with kinking. Twelve patients with symptomatic carotid stenosis and kinking demonstrated by digital subtraction angiography (DSA) received CAS from December 2003 to December 2009. There were 9 male and 3 female patients, age ranged from 59 to 77 years (mean 69.3 years). All the patients' clinical, imaging, intervention and follow up data were collected and analyzed. All CAS procedures were successfully performed with 14 self-expandable stents placed. The mean degree of stenosis was reduced from 85.6% before stenting to 11.2% after stenting, the angle of kinking, according to Metz' category, were improved from less than 90° to more than 120° in each case. No perioperative procedure related stroke and transient ischemic attack (TIA) occurred. The clinical symptoms and signs of cerebral ischemia were improved or disappeared for all patients. During follow-up of these 12 patients for 6 to 72 months, one patient experienced ipsilateral carotid territory TIA and another patient experienced contralateral carotid territory TIA. DSA follow up of 5 patients demonstrated 1 case with in-stent restenosis and arterial kinking remote to the stent of internal carotid artery. CAS were performed again and CT angiography follow up demonstrated no kinking and restenosis 2 years after the intervention. Duplex scan of the other 7 patients demonstrated neither kinking nor restenosis. CAS seems to be feasible and safe for the patients with symptomatic kinking and stenosis, and maybe helpful to lower the risk of cerebral ischemia, but further study is needed.

Reconstructive vascular operation for kinking of internal carotid artery

To evaluate and summarize the possibility and experience of reconstructive vascular operation for kinking of internal carotid artery. Reconstructive vascular operation was performed on 5 patients with symptomatic kinking of internal carotid artery between July 2008 and June 2009. There were 2 male and 3 female patients, age ranged from 53 to 68 years (mean 62 years). Cutting the internal carotid artery at the bifurcation, mobilizing and stretching the internal carotid artery, then anastomosing the internal and common carotid artery. Two of them underwent endarterectomy simultaneously. For the 5 patients, postoperative recovery went smoothly and symptoms were well improved. Except that mild high perfusion syndrome happened in 1 patient, no other obvious complications. Kinking of internal carotid artery had been stretched in the postoperative CT angiography. In the 5-16-month follow-up, no transient ischemic attack or cerebral infarction happened, and no restenosis appeared. Reconstructive vascular operation is an effective surgical approach to kinking and coiling of the internal carotid artery. For some risk exists, all-round evaluation should be performed before operation, and operative indication should be strictly controlled.

Results in a Consecutive Series of 83 Surgical Corrections of Symptomatic Stenotic Kinking of the Internal Carotid Artery

Conclusion: Surgical correction for symptomatic kinking of the internal carotid artery (ICA) is safe, effectively relieves hemispheric symptoms, and prevents stroke. Summary: The authors sought to evaluate the efficacy of surgical correction of ICA kinking. Patients in this consecutive series of 81 patients (mean age, 64 years) all had hemispheric symptoms and were all on antiplatelet therapy. They underwent 83 surgical procedures to correct ICA kinking. Procedures used included shortening and reimplanting the vessel on the common carotid artery, interposition bypass grafts, or transposing the ICA onto the external carotid artery. Mean follow-up was 56 months (range, 15-135 months). The primary end points were 30-day mortality and any stroke during follow-up. There were no operative deaths. Operative stroke rate was 1%. Primary patency of the reconstruction was 89% ± 4.1% at 5 years. At 5 years, freedom from neurologic symptoms was 92% ± 4% and late survival was 71% ± 6%. Comment: It is important to recognize what the authors are operating on and what they are not operating on. These were kinked arteries, with resulting high-grade stenotic lesions. Elongated, tortuous, or coiled arteries were not included. The article provides good technical descriptions of the operations performed to correct stenotic kinks; however, because this is basically a case series, its overall level of evidence must be considered low. One has to wonder why so many patients with this relatively odd problem ended up at a single center. Nevertheless, this is a large series by experienced surgeons and certainly worth reading. It makes one re-examine the role of high-grade ICA kinks with respect to the production of neurologic symptoms.

The content of copper and zinc in human ulcerated carotid plaque

Copper and zinc have significant antiatherogenic effect influencing activity of antioxidant enzymes (glutathione-peroxidase and superoxide-dismutase), mechanism of apoptosis and other mechanisms. Few studies showed increased copper and zinc concentration in atherosclerotic plaque in comparison to normal vascular tissue. The aim of the study was to compare copper and zinc concentrations in carotid artery tissue without significant atherosclerotic changes and human ulcered atherosclerotic plaque. Study was conducted on 66 patients. Carotid endarterectomy due to the significant carotid atherosclerotic changes with cerebrovascular disorders was performed in 54 patients (81.8%). Control group consisted of 12 patients (18.2%) without carotid atherosclerotic changes operated due to the symptomatic kinking and coiling of carotid artery. Operated group consisted of 38 men (62.96%) and 16 women (37.04%). Control group had the same number of patients: six men (50%) and six women (50%). Preoperatively, all patients were examined by vascular surgeon, neurologist and cardiologist. Duplex sonography of carotid and vertebral arteries was performed by Aloca DSD 630 ultrasound with mechanical and linear transducer 7.7 MHz. Indication for surgical treatment was obtained according to non-invasive diagnostic protocol and neurological symptoms. Copper and zinc concentration in human ulcered atherosclerotic plaque and carotid artery segment were estimated by spectrophotometry (Varian AA-5). Average age of our patients was 59.8+/-8.1 years. For males average age was 76.1+/-9.8 years. And for females 42.4+/-5.8 years. In group with carotid endarterectomy female patients were significantly younger than male patients (p<0.01). In group with carotid endarterectomy clinically determined neurological disorders were found in 47 patients (87.03%)--35 male (74.47%) and 12 female patients (25.53%). Regarding risk factors for cardiovascular diseases, no significant difference among groups was found for blood pressure and smoking. However, patients with carotid endarterectomy had significantly more diabetes mellitus (p<0.05), obesity (p<0.01) and hypercholesterolemia (p<0.01). Our study showed significantly lower total copper value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). We also found significantly lower total zinc value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). Our study revealed significant difference in copper and zinc content between human ulcered atherosclerotic plaque and normal carotid tissue. Closer correlation of these oligoelements and endothelial dysfunction will be established in future investigations.

Revascularization of the internal carotid artery for isolated, stenotic, and symptomatic kinking.

The operation for isolated, stenotic, and symptomatic kinking of the internal carotid artery is safe and effective in preventing stroke and relieving the symptoms of cerebral ischemia. A consecutive sample clinical study with a mean follow-up of 44 months. The surgical department of an academic tertiary care center and an affiliated secondary care center. Fifty-four patients with a mean age of 67 years underwent 55 revascularizations of the internal carotid artery. The surgical procedures consisted of the following: shortening and reimplantation in the common carotid artery in 36 cases, bypass grafting in 15 cases, and transposition into the external carotid artery in 4 cases. Cumulative survival, primary patency, and stroke-free and neurologic symptom-free rates expressed by standard life-table analysis. No patients died in the postoperative period. The postoperative stroke rate was 1.8%. The cumulative rates (SEs) at 5 years were as follows: survival, 70% (10.2%); primary patency, 89% (7.8%); overall stroke free, 92% (6.8%); ipsilateral stroke free, 96% (5.3%); neurologic symptom free, 90% (7.5%); and ipsilateral symptom free, 93% (6.5%). Revascularization of the internal carotid artery for the treatment of isolated, stenotic, and symptomatic kinking is safe and effective in preventing stroke and relieving symptoms of cerebrovascular insufficiency.

A simple method for combined carotid endarterectomy and correction of internal carotid artery kinking.

Occasionally symptomatic kinking of the internal carotid artery will require correction. More frequently one must rectify a kink that occurs after bifurcation endarterectomy when associated with a redundant internal carotid artery. Most procedures described for shortening of the carotid artery are somewhat cumbersome when endarterectomy is also performed or require the use of patch closure. Herein we described a technique for combined endarterectomy of the bifurcation and straightening of a critically angulated internal carotid artery. The approach obviates many of the difficulties encountered with other methods.