EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUZhongyin ¹ , XIONGJiang ¹ , WEIRen ² , JIASenhao ¹ , LIUJie ¹ , DUANChen ² , LIUXiaoping ¹ , JIAXin ¹ ,  GUOWei ¹

1. Department of Vascular Surgery, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. Medical College of Nankai University;

Corresponding author：

GUOWei, Email: pla301dml@vip.sina.com

Keywords：

Common carotid artery; Artery tortuosity; Vascular reconstruction; Transient ischemic attack

DOI：

10.7507/1002-1892.20150071

Video：

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Objective To investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT). Methods A retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually. Results The surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58±9.54) mm Hg (1 mm Hg=0.133 kPa) at pre-operation to (5.50±2.39) mm Hg at immediate after operation (t=15.492, P=0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17±6.24) mm Hg and (82.67±6.51) mm Hg from (152.83±14.80) mm Hg and (94.17±11.30) mm Hg at pre-operation (t=5.751, P=0.000; t=4.976, P=0.000). Conclusion Vascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.

Citation： WUZhongyin, XIONGJiang, WEIRen, JIASenhao, LIUJie, DUANChen, LIUXiaoping, JIAXin, GUOWei. EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 335-338. doi: 10.7507/1002-1892.20150071 Copy

1.	Aleksic M, Schütz G, Gerth S, et al. Surgical approach to kinking and coiling of the internal carotid artery. J Cardiovasc Surg (Torino), 2004, 45(1):43-48.
2.	Vannix RS, Joergenson EJ, Carter R. Kinking of the internal carotid artery. Clinical significance and surgical management. Am J Surg, 1977, 134(1):82-89.
3.	Metz H, Murray-Leslie RM, Bannister RG, et al. Kinking of the internal carotid artery. Lancet, 1961, 1(7174):424-426.
4.	Choi G, Han SH, Choi JO. Tortuous common carotid artery encountered during neck dissection. Eur Arch Otorhinolaryngol, 1998, 255(5):269-270.
5.	Ozcan KM, Ozcan I, Selcuk A, et al. Tortuous internal carotid artery narrowing pyriform sinus:two cases. Clin Imaging, 2008, 32(3):220-222.
6.	Ballotta E, Thiene G, Baracchini C, et al. Surgical vsmedical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients:a prospective randomized clinical study. J Vasc Surg, 2005, 42(5):838-846.
7.	Mumoli N, Cei M. Asymptomatic Carotid Kinking. Circ J, 2008, 72(4):682-683.
8.	Illuminati G, Calió FG, Papaspyropoulos V, et al. Revascularization of the internal carotid arteryfor isolated, stenotic, and symptomatic kinking. Arch Surg, 2003,138(2):192-197.
9.	Ding D, Starke RM, Durst CR, et al. Modification of a braided support catheter into a rapid exchange system for navigation of a distal protection device through significant vascular tortuosity. Interv Neuroradiol, 2014, 20(6):663-668.
10.	Gavrilenko AV, Kuklin AV, Khripkov AS, et al. Assessment of efficacy of reconstructive operations on carotid arteries in combination of stenosis and pathological tortuosity. Angiol Sosud Khir, 2014, 20(3):116-122.
11.	Lin LM, Colby GP, Jiang B, et al. Classification of cavernous internal carotid artery tortuosity:a predictor of procedural complexity in Pipeline embolization. J Neurointerv Surg, 2014.[Epub ahead of print].
12.	Gürbüzler L, Eyibilen A, Aladağ I. Tortuosity of the internal carotid artery detected during tonsillectomy:two case reports. Kulak Burun Bogaz Ihtis Derg, 2013, 23(2):119-122.
13.	Cvetko E. Concurrence of bilateral kinking of the extracranial part of the internal carotid artery with coiling and tortuosity of the external carotid artery-a case report. Rom J Morphol Embryol, 2014, 55(2):433-435.
14.	Kaneko K, Akita M, Murata E, et al. Unilateral anomalous left common carotid artery; a case report. Ann Anat, 1996, 178(5):477-480.
15.	Illuminati G, Ricco JB, Calio FG, et al. Results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery. Surgery, 2008, 143(1):134-139.
16.	Ridker PM, Cook NR, Lee IM, et al. A randomized trial oflow-dose aspirin in the primary prevention of cardiovasculardisease in women. N Engl J Med, 2005, 352(13):1293-1304.
17.	Rothwell PM, Eliasziw M, Gutnikov SA, et al. Endarterectomy forsymptomatic carotidstenosisinrelation to clinicalsubgroupsandtiming of surgery. Lancet, 2004, 363(9413):915-924.
18.	给娜. 动脉血压调节实验中设计颈动脉窦综合症项目浅谈. 卫生职业教育, 2010, 28(14):69.
19.	张尧, 李永坤, 蔡乾昆, 等. 颈动脉支架置入术后过度灌注综合征的危险因素分析. 中华老年心脑血管病杂志, 2013, 15(2):115-118.
20.	Paraskevas KI, Liapis CD, Hamilton G, et al. Can statins reduce perioperative morbidity and mortality in patients undergoing non-cardiac vascular surgery? Eur J Vasc Endovasc Surg, 2006, 32(3):286-293.

1. Aleksic M, Schütz G, Gerth S, et al. Surgical approach to kinking and coiling of the internal carotid artery. J Cardiovasc Surg (Torino), 2004, 45(1):43-48.
2. Vannix RS, Joergenson EJ, Carter R. Kinking of the internal carotid artery. Clinical significance and surgical management. Am J Surg, 1977, 134(1):82-89.
3. Metz H, Murray-Leslie RM, Bannister RG, et al. Kinking of the internal carotid artery. Lancet, 1961, 1(7174):424-426.
4. Choi G, Han SH, Choi JO. Tortuous common carotid artery encountered during neck dissection. Eur Arch Otorhinolaryngol, 1998, 255(5):269-270.
5. Ozcan KM, Ozcan I, Selcuk A, et al. Tortuous internal carotid artery narrowing pyriform sinus:two cases. Clin Imaging, 2008, 32(3):220-222.
6. Ballotta E, Thiene G, Baracchini C, et al. Surgical vsmedical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients:a prospective randomized clinical study. J Vasc Surg, 2005, 42(5):838-846.
7. Mumoli N, Cei M. Asymptomatic Carotid Kinking. Circ J, 2008, 72(4):682-683.
8. Illuminati G, Calió FG, Papaspyropoulos V, et al. Revascularization of the internal carotid arteryfor isolated, stenotic, and symptomatic kinking. Arch Surg, 2003,138(2):192-197.
9. Ding D, Starke RM, Durst CR, et al. Modification of a braided support catheter into a rapid exchange system for navigation of a distal protection device through significant vascular tortuosity. Interv Neuroradiol, 2014, 20(6):663-668.
10. Gavrilenko AV, Kuklin AV, Khripkov AS, et al. Assessment of efficacy of reconstructive operations on carotid arteries in combination of stenosis and pathological tortuosity. Angiol Sosud Khir, 2014, 20(3):116-122.
11. Lin LM, Colby GP, Jiang B, et al. Classification of cavernous internal carotid artery tortuosity:a predictor of procedural complexity in Pipeline embolization. J Neurointerv Surg, 2014.[Epub ahead of print].
12. Gürbüzler L, Eyibilen A, Aladağ I. Tortuosity of the internal carotid artery detected during tonsillectomy:two case reports. Kulak Burun Bogaz Ihtis Derg, 2013, 23(2):119-122.
13. Cvetko E. Concurrence of bilateral kinking of the extracranial part of the internal carotid artery with coiling and tortuosity of the external carotid artery-a case report. Rom J Morphol Embryol, 2014, 55(2):433-435.
14. Kaneko K, Akita M, Murata E, et al. Unilateral anomalous left common carotid artery; a case report. Ann Anat, 1996, 178(5):477-480.
15. Illuminati G, Ricco JB, Calio FG, et al. Results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery. Surgery, 2008, 143(1):134-139.
16. Ridker PM, Cook NR, Lee IM, et al. A randomized trial oflow-dose aspirin in the primary prevention of cardiovasculardisease in women. N Engl J Med, 2005, 352(13):1293-1304.
17. Rothwell PM, Eliasziw M, Gutnikov SA, et al. Endarterectomy forsymptomatic carotidstenosisinrelation to clinicalsubgroupsandtiming of surgery. Lancet, 2004, 363(9413):915-924.
18. 给娜. 动脉血压调节实验中设计颈动脉窦综合症项目浅谈. 卫生职业教育, 2010, 28(14):69.
19. 张尧, 李永坤, 蔡乾昆, 等. 颈动脉支架置入术后过度灌注综合征的危险因素分析. 中华老年心脑血管病杂志, 2013, 15(2):115-118.
20. Paraskevas KI, Liapis CD, Hamilton G, et al. Can statins reduce perioperative morbidity and mortality in patients undergoing non-cardiac vascular surgery? Eur J Vasc Endovasc Surg, 2006, 32(3):286-293.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF SURGICAL TREATMENT OF SYMPTOMATIC TORTUOSITY COMMON CAROTID ARTERY

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