Carotid artery tortuosity

Kinking and coiling of the internal carotid artery is a condition of congenital or acquired origin. It refers to the tortuous shape that the internal carotid artery adopts in the extracranial portion^1,2.

Clinical presentation

It occurs mainly with neurological disorders³.

• Dizziness
• Lipothymia
• Ear Buzz
• Syncope
• Paraesthesia

Pathology

In acquired cases, the main factors are atheromatous disease, high blood pressure, and ageing. In congenital cases, it has been attributed to a failure in the development process of the third aortic arch and the dorsal aorta in the embryonic period ³.

Classification

They can be classified into 3 different types⁴.

• Type 1: Artery with a non-rectilinear section and an angle greater than 90º.
• Type 2: Artery with a section in the form of a curl that generates an angle of 360º about its transverse axis.
• Type 3: Twist from the bending of 2 or more segments of an artery with an internal angle of 90.

Radiographic features

Ultrasound

• Morphological features in grayscale.
• Haemodynamic values in spectral Doppler.

CT angiography

It allows us to perform a 3D reconstruction and a precise assessment of the degree of tortuosity of the artery.

Angiography

It allows us to characterise the type of tortuosity and has a high sensitivity to detect it.

Treatment

• Arterial transposition is criticised for not removing arterial elongation.
• Vascular procedures such as segmental resection and end to end anastomosis.
• Endarterectomy technique with eversion, which allows correction of severe elongation and kinking of the ICA⁵.