Kinks, coils, and carotids: a review

Area of Science:

• Vascular Surgery
• Neurology
• Cerebrovascular Disease

Background:

• Kinking and coiling of the internal carotid artery (ICA) are anatomical variations that may be associated with cerebrovascular symptoms.
• While definitive evidence is lacking, these conditions warrant consideration in patients presenting with cerebrovascular disease.
• Kinking is often linked to atherosclerosis, whereas coiling is typically of embryological origin.

Purpose of the Study:

• To evaluate the association between internal carotid artery kinking and symptomatic cerebrovascular disease.
• To assess the potential benefits of surgical correction for patients with symptomatic ICA kinking.

Main Methods:

• Review of clinical evidence and angiographic findings in patients with ICA kinking and coiling.
• Analysis of patient outcomes following surgical intervention for symptomatic ICA kinking.

Main Results:

• Kinking of the ICA, particularly when exacerbated by head rotation, can obstruct blood flow and lead to transient ischemic attacks (TIAs) in adults.
• Surgical correction appears most beneficial for adults experiencing recurrent TIAs associated with ICA kinking.
• Coiling of the ICA is generally asymptomatic and recommendations for surgical intervention in infants are not established.

Conclusions:

• Symptomatic internal carotid artery kinking, especially in adults with TIAs aggravated by head movement, is a strong indication for surgical consideration.
• Distinguishing between atherosclerotic kinking and embryological coiling is crucial for appropriate patient management.
• Further research may clarify the role of surgical intervention for ICA kinking and coiling in specific patient populations.