Carotid artery tortuosity

Last revised by Yaïr Glick on 3 May 2022

Carotid artery tortuosity is the elongation of the extracranial carotid arteries with redundancy and/or altered course, which may present on imaging as kinking, coiling, and/or looping 1,2.

Carotid artery tortuosity is mostly (~80%) asymptomatic. When symptomatic (~12.5%, range 4-20%), it presents with neurological symptoms (e.g. dizziness, tinnitus, stroke3,4.

The pathogenesis of carotid artery tortuosity is unknown 4.

Carotid artery tortuosity can be classified into three different types 4:

  • type 1: artery with a non-rectilinear section and an angle >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 segments of an artery with an internal angle of 90º
  • morphological features in grayscale
  • hemodynamic values in spectral Doppler

CT angiography allows for 3D reconstruction and a precise assessment of the degree of tortuosity of the artery.

Angiography allows characterizing the type of tortuosity and has a high sensitivity to detect it.

  • arterial transposition is criticized for not removing arterial elongation
  • vascular surgery, e.g. segmental resection and end-to-end anastomosis
  • endarterectomy technique with eversion, which allows correction of severe elongation and kinking of the ICA 5

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Cases and figures

  • Case 1: looped ICA (arrow)
    Drag here to reorder.
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