Prospective evaluation of hypertensive patients with carotid kinking and coiling: an ultrasonographic 7-year study
Ugo Oliviero1, Giovanna Scherillo, Cosma Casaburi
1Department of Clinical Medicine, Cardiovascular and Immunological Science, Federico II University, Naples, Italy. uolivier@unina.it
Insights
Hypertensive patients with internal carotid artery kinking showed lower carotid intima-media thickness. This condition, however, did not increase the risk of vascular events over seven years.
Area of Science:
- Vascular Medicine
- Neurology
- Cardiology
Background:
- Hypertension is a major risk factor for vascular events.
- Internal carotid artery kinking is a condition that may affect cerebral blood flow.
- The relationship between carotid kinking and vascular events in hypertensive patients requires further investigation.
Purpose of the Study:
- To evaluate the incidence of vascular events in hypertensive patients with internal carotid artery kinking.
- To assess carotid intima-media thickness (IMT) in these patients.
- To determine if carotid kinking is an independent risk factor for ischemic events in hypertension.
Main Methods:
- A 7-year follow-up study comparing 34 hypertensive patients with carotid kinking to 36 matched hypertensive controls.
- Ultrasonographic measurement of carotid intima-media thickness (IMT) at the carotid bifurcation and points of carotid kinking.
- Recording of vascular events during the follow-up period.
Main Results:
- Mean IMT was significantly lower at the carotid kinking site and ipsilateral bifurcation compared to contralateral sites and controls (p < 0.01).
- Vascular events occurred in 10 patients with carotid kinking and 14 controls over 7 years, with no significant difference.
- Carotid kinking did not emerge as an independent risk factor for vascular events in this hypertensive cohort.
Conclusions:
- Internal carotid artery kinking in hypertensive individuals is associated with reduced IMT at the kinking site and ipsilateral bifurcation.
- Carotid kinking does not appear to increase the risk of vascular events in hypertensive patients.
- The presence of carotid kinking should not be considered an additional risk factor for ischemic events in hypertensive populations.
Abstract:
The aim of this study was to determine the incidence of vascular events during a 7-year follow-up evaluation in a group of 34 hypertensive patients with kinking of the internal carotid artery and 36 well-matched hypertensive control subjects. The carotid intima-media thickness (IMT) was measured at three points of the carotid bifurcation and at three points of carotid kinking on the ultrasonographic posterior wall. The mean IMT measured in the segment of the angular bending was lower than the mean values detected at the bifurcation in normal subjects and in hypertensives without carotid elongation (p < 0.01). At the carotid bifurcation of the same side of the kinking, there was an arterial IMT that was significantly lower as compared to the contralateral axis and to the measurements obtained in other hypertensive subjects. During a 7-year follow-up study, 10 vascular events occurred in the hypertensives with carotid kinking and 14 in the controls, without significant differences between the 2 groups. In hypertensives with carotid kinking, the mean IMT measured on the angular bending and at the ipsilateral carotid bifurcation was significantly lower than the values obtained at the contralateral bifurcation and in the other hypertensive subjects. In the 7-year follow-up study, moreover, the presence of carotid kinking does not impact the incidence of vascular events in the hypertensive population. Thus, the presence of carotid kinking in hypertensive subjects may not be considered a further risk factor for ischemic events.
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