[Pathological tortuosity of extracranial arteries: a problem long known, but not yet solve]

This article describes the historical data concerning elongated and tortuous brachiocephalic arteries, the first diagnostic methods for confirming tortuosity of carotid arteries, and analyzes the modern approach to the treatment of pathological tortuosity, particularly that of the internal carotid artery. A critical interpretation of the very term 'pathological tortuosity' (PT) is given, with the classification and causes of the disease also touched upon. A number of sporadic publications putting forward rather controversial theories of the mechanisms of the development of pathological tortuosity are questioned. Enumerated are the indications for surgery for PT, that correspond to the National Clinical Guidelines. They reflect inconsistency of approaches in the treatment of pathological tortuosity of internal carotid arteries. The main thesis of the authors is that tortuosity of internal carotid arteries, undoubtedly being a common phenomenon, nevertheless requires active surgical tactics only in a very limited number of patients with symptoms of cerebrovascular insufficiency.