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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1998 October;39(5):557-63

language: English

Surgical treat­ment of ­kinked inter­nal carot­id ­artery

Radonic V., Baric D., Giunio L.*, Buca A.**, Sapunar D.***, Marovic A.****

From the Department of Surgery, *Department of Internal Medicine, **Department of Radiology, ***Faculty of Medicine and ****Department of Neurology, Clinical Hospital, Split, Croatia


Background and ­aims. The aim of ­this ­study was to pro­vide infor­ma­tion on the diag­no­sis and treat­ment of kink­ing - ­bends in the extra­cra­ni­al inter­nal carot­id ­artery (­KICA), a ­rate but ­major and treat­able ­cause of cere­bral ische­mia.
Project. A ret­ro­spec­tive ­review of ­the sev­en-­year expe­ri­ence in Split Hospital.
Essential ­data. The ­role of the sur­gi­cal cor­rec­tion of carot­id ­artery kink­ing has not yet ­been pre­cise­ly ­defined.
Materials and meth­ods. Of the 86 carot­id revas­cu­lar­iza­tion oper­a­tions per­formed in 76 ­patients ­from 1988 to 1994, 21 (29%) ­patients under­went sur­gery ­owing to symp­to­mat­ic kink­ing of the inter­nal carot­id ­artery. This ­group includ­ed 8 ­females and 13 ­males ­with a ­mean age of 57.3±5.5 ­years (­range 44-70). Symptoms includ­ed cereb­ro­vas­cu­lar ­insults in 43%, hem­i­spher­ic tran­si­ent ischem­ic ­attacks in 33%, rever­sible ischem­ic neu­ro­log­i­cal def­i­cit in 24% of ­patients. The diag­no­sis was ­made ­using two-dimen­sion­al ultra­sound ­scan and Doppler, com­pu­ter­ised tomog­ra­phy and angio­graph­ic eval­u­a­tion. Two meth­ods ­were ­used: the elim­i­na­tion of kink­ing and ­graft of the inter­nal ­artery ­onto the com­mon carot­id ­artery ­with exci­sion of the ­kinked sec­tion of the ­artery and end-to-end anas­tom­o­sis. Dense ­fibrous tis­sues ­around the ­kinked ­artery ­were ­removed and the ­artery was ­freed ­along its ­entire ­course. The anom­a­lous rela­tion­ship ­between the inter­nal carot­id ­artery, occip­i­tal ­artery and hypo­glos­sal ­nerve was cor­rect­ed.
Results. After sur­gery sev­en­teen ­patients ful­ly recov­ered with­out neu­ro­log­i­cal com­pli­ca­tions. One ­patient ­died, one ­patient suf­fered per­ma­nent neu­ro­log­i­cal def­i­cit, two suf­fered ­from tran­sient ischem­ic ­attacks.
Conclusions. Anatomic recon­struc­tion togeth­er ­with the cor­rec­tion and elim­i­na­tion of the affect­ed seg­ments of the carot­id ­artery may pre­vent pro­gres­sive cereb­ro­vas­cu­lar symp­toms and is asso­ciat­ed ­with a low mor­bid­ity and mor­tal­ity ­rate.

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