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[Surgery of the kinking carotid artery]
G Ghilardi1, F Longhi, M De Monti
1Istituto di Chirurgia Generale e Cardiovascolare, Università degli Studi di Milano.
Insights
Symptomatic carotid kinking requires surgical intervention, while asymptomatic cases benefit from conservative management with antiplatelet therapy. This approach ensures patient safety and effective treatment for carotid artery conditions.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Context:
- Carotid artery kinking is a condition affecting cerebral blood flow.
- Diagnosis and management strategies for carotid artery kinking have evolved.
- Long-term outcomes of surgical and conservative treatments are crucial.
Purpose:
- To evaluate the clinical outcomes of surgical and conservative management for carotid artery kinking.
- To determine the appropriate treatment strategy based on patient symptoms and disease severity.
- To assess the long-term patency and neurological status of treated patients.
Summary:
- A study observed 43 cases of carotid artery kinking between 1971 and 1992.
- Four patients with transient ischemic attacks underwent surgical resection and reconstruction, with successful outcomes.
- Thirty-nine asymptomatic patients received conservative management with antiplatelet therapy, showing no disease progression or symptoms.
Impact:
- Conservative management is recommended for asymptomatic carotid kinking.
- Surgical intervention is reserved for symptomatic patients with confirmed ischemic attacks not attributable to other causes.
- This study guides clinical decision-making in managing carotid artery kinking, emphasizing a tailored, evidence-based approach.
Abstract:
Forty-three kinkings of the epiarotic vessels were observed at the Istituto di Chirurgia Generale e Cardiovascolare dell'Università di Milano from January 1st 1971 through July 31st 1992. Six subjects were admitted for a history of one or more transient ischemic attacks. In four cases surgical resection of the kinked tract of the internal carotid and end-to-end direct reconstruction was carried out, completed by carotid bifurcation endarterectomy in three, where atherosclerotic carotid disease was severe. All the reconstructions are currently patent and no neurological symptoms were recorded at follow-up; 39 cases were treated conservatively by antiplatelet therapy and controlled each six months: to date no worsening of the echocolordoppler imaging of the lesion was noted, and all these subjects remained completely asymptomatic. The authors point out that correct clinical approach to carotid kinking is a conservative one: surgical operation must be performed only in those subjects affected with cerebral ischemic attacks not justified by other diseases.