Anatomical variations of cervical segment of internal carotid artery in patients with subarachnoid hemorrhage

Year 2022, Volume: 39 Issue: 3, 776 - 780, 30.08.2022

Aykan Ulus , Cengiz Cokluk , Abdullah Hilmi Marangoz , Enis Kuruoglu

Abstract

The cervical segment of internal carotid artery (cICA) usually has straight vertical course without any branching. In the present study, variations of the cICA were evaluated based on the three-dimensional volume rendered neurovascular images. The computed tomography angiography images of 56 patients, diagnosed with subarachnoid hemorrhage (SAH), were evaluated retrospectively. Two separate researchers, blinded to each other and clinical information of the patients, evaluated the courses of cICA bilaterally. The variations were classified as tortuosity, kinking, and coiling. Total 112 cICA segment of 56 patients were evaluated. The cICA variations were present in 21.4% of patients and 17.9% of segments. There was tortuosity in 5 (8.9%) patients, kinking in 4 (7.1%) patients, and coiling in 6 (10.7%) patients. Of 41 patients with aneurysmal SAH, there was a cICA variation in 8 (19.5%) patients. A cICA variation was detected in 4 (26.7%) of 15 patients with idiopathic SAH. The cICA variation ratio in SAH patients was concordant with studies performed in different patient groups. Although the ratio was slightly higher in idiopathic SAH patients, there was no statistical significance between aneurysmal and idiopathic SAH groups. The coiling was more frequent in SAH patients compared to previous studies. The cICA variations tend to be bilateral in SAH patients.

Keywords

internal carotid artery, tortuosity, coiling, kinking, subarachnoid hemorrhage, dolichoarteriopathy

References

• Fischer E. Die Lageabweichungen der vorderen hirnarterie im gefassbild. Zentralbl Neurochir. 1938;3:300-13.
• Bouthillier A, van Loveren HR,Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery. 1996;38(3):425-32; discussion 32-3.
• Paulsen F, Tillmann B, Christofides C, Richter W,Koebke J. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat. 2000;197 Pt 3:373-81.
• Weibel J,Fields WS. Tortuosity, Coiling, and Kinking of the Internal Carotid Artery. I. Etiology and Radiographic Anatomy. Neurology. 1965;15:7-18.
• Beigelman R, Izaguirre AM, Robles M, Grana DR, Ambrosio G,Milei J. Are kinking and coiling of carotid artery congenital or acquired? Angiology. 2010;61(1):107-12.
• Khasiyev F, Rundek T, Di Tullio MR, Wright CB, Sacco RL, Elkind MSV, et al. Systemic Arterial Correlates of Cervical Carotid Artery Tortuosity : The Northern Manhattan Study. Clin Neuroradiol. 2021.
• Cairney J. Tortuosity of the Cervical Segment of the Internal Carotid Artery. J Anat. 1924;59(Pt 1):87-96.
• Metz H, Murray-Leslie RM, Bannister RG, Bull JW,Marshall J. Kinking of the internal carotid artery. Lancet. 1961;1(7174):424-6.
• Del Corso L, Moruzzo D, Conte B, Agelli M, Romanelli AM, Pastine F, et al. Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging? Angiology. 1998;49(5):361-71.
• Pancera P, Ribul M, Presciuttini B,Lechi A. Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension? J Intern Med. 2000;248(1):7-12.
• Han HC. Twisted blood vessels: symptoms, etiology and biomechanical mechanisms. J Vasc Res. 2012;49(3):185-97.
• La Barbera G, La Marca G, Martino A, Lo Verde R, Valentino F, Lipari D, et al. Kinking, coiling, and tortuosity of extracranial internal carotid artery: is it the effect of a metaplasia? Surg Radiol Anat. 2006;28(6):573-80.
• Danza R, Baldizan J,Navarro T. Surgery of carotid kinking and fibromuscular dysplasia. J Cardiovasc Surg (Torino). 1983;24(6):628-33.
• Liu J, Jia XJ, Wang YJ, Zhang M, Zhang T,Zhou HD. Digital subtraction angiography imaging characteristics of patients with extra-intracranial atherosclerosis and its relationship to stroke. Cell Biochem Biophys. 2014;69(3):599-604.
• Sacco S, Totaro R, Baldassarre M,Carolei A. Morphological variations of the internal carotid artery: Prevalence, characteristics and association with cerebrovascular disease. Int J Angiol. 2007;16(2):59-61.
• Riser M, Geraud J, Ducoudray J,Ribaut L. Dolichocarotide interne avec syndrome vertigineux. Rev Neurol (Paris). 1951;85(2):145-7.
• Togay-Isikay C, Kim J, Betterman K, Andrews C, Meads D, Tesh P, et al. Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity? Acta Neurol Belg. 2005;105(2):68-72.
• Vannix RS, Joergenson EJ,Carter R. Kinking of the internal carotid artery. Clinical significance and surgical management. Am J Surg. 1977;134(1):82-9.
• Khasiyev F,Gutierrez J. Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk. J Neuroimaging. 2021;31(2):251-60.
• Kaplan ML,Bontsevich DN. Effect of the form of pathological tortuosity of the internal carotid artery on cerebral haemodynamics. Angiol Sosud Khir. 2013;19(3):102-6.
• Hosokawa S,Mineta H. Tortuous internal carotid artery presenting as a pharyngeal mass. J Laryngol Otol. 2010;124(9):1033-6.
• Eyibilen A, Baykara M,Ozbay AS. A possible cause of snoring: bilateral tortuosity of the internal carotid artery. Kulak Burun Bogaz Ihtis Derg. 2008;18(4):250-2.
• Heckmann JG, Marthol H, Bickel A, Dorfler A,Neundorfer B. Hemilingual spasm associated with tortuosity of the extracranial internal carotid artery. Cerebrovasc Dis. 2005;20(3):208-10.
• Scotti G, Melancon D,Olivier A. Hypoglossal paralysis due to compression by a tortuous internal carotid artery in the neck. Neuroradiology. 1978;14(5):263-5.
• Becker C, Ridder GJ,Pfeiffer J. The clinical impact of aberrant internal carotid arteries in children. Int J Pediatr Otorhinolaryngol. 2014;78(7):1123-7.
• Jackson JL. Tortuosity of the Internal Carotid Artery and Its Relation to Tonsillectomy. Can Med Assoc J. 1933;29(5):475-9.
• Kudva A, Dhara V, Patil BR,Sankaran M. Caution with carotids: A necessary cognizance. Oral Oncol. 2021;121:105392.
• Ding D, Starke R,Evans A. E-050 Navigation of a Distal Cerebral Embolic Protection Device through Significant Vascular Tortuosity with a Novel Rapid Exchange Catheter System during Carotid Artery Stenting. J Neurointerv Surg. 2014;6 Suppl 1:A61.
• Van Damme H, Gillain D, Desiron Q, Detry O, Albert A,Limet R. Kinking of the internal carotid artery: clinical significance and surgical management. Acta Chir Belg. 1996;96(1):15-22.
• Wang Q, Liu C, Yan B, Fan X, Zhang M, Li Y, et al. Correlation of extracranial internal carotid artery tortuosity index and intraprocedural complications during carotid artery stenting. Eur Neurol. 2012;68(2):65-72.
• Wyers MC, Powell RJ, Fillinger MF, Nolan BW,Cronenwett JL. The value of 3D-CT angiographic assessment prior to carotid stenting. J Vasc Surg. 2009;49(3):614-22.
• Jeong DE, Kim JW, Kim BM, Hwang W,Kim DJ. Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy. AJNR Am J Neuroradiol. 2019;40(5):840-4.
• Peeling L,Fiorella D. Balloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience. J Neurointerv Surg. 2014;6(2):129-33.
• Koskas F, Bahnini A, Walden R,Kieffer E. Stenotic coiling and kinking of the internal carotid artery. Ann Vasc Surg. 1993;7(6):530-40.
• Pellegrino L, Prencipe G,Vairo F. Dolicho-arteriopathies (kinking, coiling, tortuoosity) of the carotid arteries: study by color Doppler ultrasonography. Minerva Cardioangiol. 1998;46(3):69-76.
• Poulias GE, Skoutas B, Doundoulakis N, Haddad H, Karkanias G,Lyberiadis D. Kinking and coiling of internal carotid artery with and without associated stenosis. Surgical considerations and long-term follow-up. Panminerva Med. 1996;38(1):22-7.
• Petro GR, Witwer GA, Cacayorin ED, Hodge CJ, Bredenberg CE, Jastremski MS, et al. Spontaneous dissection of the cervical internal carotid artery: correlation of arteriography, CT, and pathology. AJR Am J Roentgenol. 1987;148(2):393-8.
• Saba L, Argiolas GM, Sumer S, Siotto P, Raz E, Sanfilippo R, et al. Association between internal carotid artery dissection and arterial tortuosity. Neuroradiology. 2015;57(2):149-53.
• Hamada J, Kai Y, Morioka M, Kaku T, Korematsu K,Ushio Y. Tortuosity of the Cervical Segment of the Internal Carotid Artery in AVM Patients. Interv Neuroradiol. 1997;3 Suppl 2:133-6.
• Nikiforov BM,Rudenko I. Tortuosity of the internal carotid artery. Zh Nevropatol Psikhiatr Im S S Korsakova. 1981;81(7):977-80.