Top

Published in:

Open Access 01-12-2007 | Case report

Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Authors: Nikolai A Ovchinnikov, Ramesh T Rao, Suresh R Rao

Published in: Head & Face Medicine | Issue 1/2007

Abstract

Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature.

Available only for authorised users

Faries PL, Chaer RA, Patel S, Lin SC, DeRubertis B, Kent KC: Current management of extracranial carotid artery disease. Vascular and Endovascular Surgery. 2006, 40 (3): 165-175. 10.1177/153857440604000301.CrossRefPubMed

Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ, editors: Grays Anatomy. 1999, Lippincott Williams & Wilkins, 1523-38

Bergman RA, Afifi AK, Miyauchi R: Internal Carotid Artery. Illustrated Encyclopedia of Human Anatomic Variation. Opus II: Cardiovascular System: Arteries: Head, Neck, and Thorax. [http://www.anatomyatlases.org/]

Bergman RA, Thompson SA, Afifi AK: Compendium of Human Anatomic Variation: Text, Atlas, and World Literature. cardiovascular system. 1988, Urban & Schwarzenberg, 66-

Caldemeyer KS, Carrico JB, Mathews VP: The radiology and embryology of anomalous arteries of the head and neck. AJR. 1998, 170: 197-203.CrossRefPubMed

Jackel M: Anatomic variants of the internal carotid artery as differential parapharyngeal space-occupying lesions diagnosis. HNO. 1997, 45 (12): 1018-1021. 10.1007/s001060050187.CrossRefPubMed

Moore KL: The developing human: Clinically oriented embryology. 1988, Philadelphia: W.B. Saunders, 291, 314-4

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 (3): 373-381. 10.1046/j.1469-7580.2000.19730373.x.CrossRefPubMedPubMedCentral

Uchino A, Sawada A, Takase Y, Kudo S: MR angiography of anomalous branches of the internal carotid artery. AJR. 2003, 181: 1409-1414.CrossRefPubMed

10.

Yilmaz E, Ilgit E, Taner D: Primitive persistent carotid-basilar and carotid-vertebral anastomoses: a report of seven cases and a review of the literature. Clin Anat. 1995, 8 (1): 36-43. 10.1002/ca.980080107.CrossRefPubMed

11.

Kelly AB: Tortuosity of the internal carotid artery in relation to the pharynx. J Laryngol Otol. 1925, 40: 15-22.CrossRef

12.

Ziyal IM, Özgen T, Sekhar LN, Özcan OE, Cekirge S: Proposed classification of segments of the internal carotid artery: Anatomical study with angiographical interpretation. Shinkei Geka. 2005, 45 (4): 184-191.PubMed

13.

Quattlebaum JK, Wade JS, Whiddon CM: Stroke associated with elongation and kinking of the carotid artery: long-term follow-up. Ann Surg. 1973, 177 (5): 572-579. 10.1097/00000658-197305000-00010.CrossRefPubMedPubMedCentral

14.

Aydin E, Akkuzu G, Akkuzu B, Ozluoglu LN: Tortuous internal carotid artery indenting the piriform sinus: a case report. European Archives of Otorhinolaryngol. 2005, 262 (4): 351-352. 10.1007/s00405-004-0810-4.CrossRef

15.

Bruno G, Sebastiano B, Giuseppe A, Giancarla C, Giuseppe R, Carmelo Q, Francesco F: Internal carotid artery transposition as risk factor in pharyngeal surgery. Laryngoscope. 2002, 112 (10): 1845-1848. 10.1097/00005537-200210000-00026.CrossRef

16.

Ricciardelli E, Hllel AD, Schwartz AN: Aberrant carotid artery. Presentation in the near midline pharynx. Arch Otolaryngol Head Neck Surg. 1989, 115 (4): 519-522.CrossRefPubMed

17.

Schumacher WA, Schafig A, Kehrl W, Pau HW: Variations in the course of the internal carotid artery: possible risks in so-called standard operations in the area of the pharynx. Laryngorhinootologie. 1998, 77 (9): 517-20.CrossRefPubMed

18.

Tillmann B, Christofides C: The "dangerous loop" of the internal carotid artery. An anatomic study. HNO. 1995, 43 (10): 601-604.PubMed

19.

Vega J, Gervas C, Vega-Hazas G, Barrera C, Biurrun C: Internal carotid artery transposition: another cause of widening of the retropharyngeal space. Eur Radiol. 1999, 9 (2): 347-348. 10.1007/s003300050678.CrossRefPubMed

20.

Ballotta E, Abbruzzese E, Thiene G, Bottio T, Dagiau G, Angelini A, Saladini M: The elongation of the internal carotid artery: early and long-term results of patients having surgery compared with unoperated controls. Annals of Vascular Surgery. 1997, 11 (2): 120-128. 10.1007/s100169900021.CrossRefPubMed

21.

Borioni R, Garofalo M, Actis Dato GM, Pierri MD, Caprara E, Albano P, Chiariello L: Kinking of internal carotid artery: is it a risk factor for cerebro-vascular damage in patients undergoing cardiac surgery?. J Cardiovasc Surg (Torino). 1994, 35 (4): 325-326.

22.

Ogretmenoglu O: Asymptomatic looping of the internal carotid artery: a case report. Kulak Burun Bogaz Ihtis Derg. 2004, 12 (5–6): 144-146.PubMed

23.

Okami K, Onuki J, Ishida K, Kido T, Takahashi M: Tortuosity of the internal carotid artery – report of three cases and MR-angiography imaging. Auris Nasus Larynx. 2001, 28 (4): 373-376. 10.1016/S0385-8146(01)00057-8.CrossRefPubMed

24.

Togay-Isikay C, Kim J, Betterman K, Andrews C, Meads D, Tesh P, Tegeler C, Oztuna D: Carotid artery tortuosity, kinking, coiling: stroke risk factor, marker, or curiosity?. Acta Neurol Belg. 2005, 105 (2): 68-72.PubMed

25.

Tomiya Y, Chiba S, Moriyama H, Kikuchi Y, Ohta M: Eighteen cases of tortuosity of the internal carotid – usefulness of MR-angiography in diagnosis. Nippon Jibiinkoka Gakkai Kaiho. 1995, 98 (9): 1367-1372.CrossRefPubMed

26.

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.PubMed

27.

Alpagut U, Ugurlucan M, Kafali E, Sayin OA, Demir T, Basaran M, Demir HB, Dayioglu E, Onursal E: Aneurysm of the kinked extracranial internal carotid artery. Case report and review of the literature. Acta chir belg. 2005, 105: 407-409.CrossRefPubMed

28.

Desai B, Toole JF: Kinks, coils, and carotids: a review. Stroke. 1975, 6 (6): 649-53.CrossRefPubMed

29.

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?. Journal of Internal Medicine. 2000, 248: 7-12. 10.1046/j.1365-2796.2000.00611.x.CrossRefPubMed

30.

Weibel J, Fields WS: Tortuosity, coiling and kinking of internal carotid artery. Etiology and radiographic anatomy. Neurology. 1965, 15: 7-18.CrossRefPubMed

31.

Aleksic M, Schutz G, Gerth S, Mulch J: Surgical approach to kinking and coiling of the internal carotid artery. J Cardiovasc Surg (Torino). 2004, 45 (1): 43-8.

32.

Koskas F, Bahnini A, Walden R, Kieffer E: Stenotic coiling and kinking of the internal carotid artery. Annals of Vascular Surgery. 1993, 7 (6): 530-540. 10.1007/BF02000147.CrossRefPubMed

33.

La Barbera G, La Marca G, Martino A, Lo Verde R, Valentino F, Lipari D, Peri G, Cappello F, Valentino B: Kinking, coiling, and tortuosity of extracranial internal carotid artery: is it the effect of a metaplasia?. Surg Radiol Anat. 2006, 28 (6): 573-580. 10.1007/s00276-006-0149-1.CrossRefPubMed

34.

Hayashi N, Hori E, Ohtani Y, Ohtani O, Kuwayama N, Endo S: Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir (Tokyo). 2005, 45: 25-30. 10.2176/nmc.45.25.CrossRef

35.

Wiseman O, Logan B, Dixon A, Ellis H: Tortuosity in the cervical part of the vertebral artery. Clin Anat. 1994, 7 (1): 26-33. 10.1002/ca.980070106.CrossRef

36.

Acland R: Acland's Cross-Sectional Navigator. Head and neck images. 2005, Lippincott Williams & Wilkins

37.

Riser M, Gerard J, Ribaut L: Dolichocarotide interne avec syndrome vertigineux. Rev Neurol. 1951, 85: 145-150.PubMed

38.

Spencer PG: Pseudostroke: acute cerebrovascular insufficiency with congenital kinking. JAMA. 1963, 186: 76-85.CrossRef

39.

Metz H, Murray-Leslie RM, Bannister RG, Bull JD, Marshall J: Kinking of the internal carotid artery in relation to cerebrovascular disease. Lancet. 1961, 1: 424-426. 10.1016/S0140-6736(61)90004-6.CrossRefPubMed

40.

Purdue GF, Pellegrini RV, Arena S: Aneurysms of the high internal carotid artery: a new approach. Surgery. 1981, 89: 268-270. PubMedPubMed

41.

Bladin CF, Alexandrov AV, Murphy J, Maggisano R, Norris JW: A New Method of Measuring Internal Carotid Artery Stenosis. Stroke. 1995, 26: 230-234.CrossRefPubMed

42.

Pappada G, Marina R, Fiori L, Agostoni E, Lanterna A, Cardia A, Ferrarese C, Beghi E, Gaini SM: Stenting of atherosclerotic stenoses of the extracranial carotid artery. Acta Neurochir (Wien). 2001, 143 (10): 1005-1011. 10.1007/s007010170005.CrossRef

43.

Saito R, Ezura M, Takahashi A, Yoshimoto T: Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect. Surg Neurol. 2000, 53 (4): 318-22. 10.1016/S0090-3019(00)00206-8.CrossRefPubMed

44.

Ord RA, Ward-Booth RP: Anomalies of the common carotid artery: a rare complication of radical neck dissection. Br J Oral Maxillofacial Surg. 1986, 24: 405-409. 10.1016/0266-4356(86)90053-7.CrossRef

45.

DePalma RG: Optimal exposure of the internal carotid artery for endarterectomy. Surg Gynecol Obstet. 1977, 144: 249-250.PubMed

46.

Fisch UP, Oldring DJ, Senning A: Surgical therapy of internal carotid artery lesions of the skull base and temporal bone. Otolaryngol Head Neck Surg. 1980, 88: 548-554.CrossRefPubMed

47.

Grego F, Lepidi S, Cognolato D, Frigatti P, Morelli I, Deriu GP: Rationale of the surgical treatment of carotid kinking. J Cardiovasc Surg (Torino). 2003, 44 (1): 79-85.

48.

Devlin MA, Hoffmann KD, Johnson WD: Comparison of mandibular surgical techniques for accessing cranial base vascular lesions. Skull Base. 2003, 13 (2): 65-72. 10.1055/s-2003-40595.CrossRefPubMedPubMedCentral

49.

Pellegrini RV, Manzetti GW, DiMarco RF, Bekoe S, Arena SA, Marrangoni AG: The direct surgical management of lesions of the high internal carotid artery. J Cardiovasc Surg (Torino). 1984, 25 (1): 29-35.

50.

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): 22-27.PubMed

Title: Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature
Authors: Nikolai A Ovchinnikov
Ramesh T Rao
Suresh R Rao
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: Head & Face Medicine / Issue 1/2007
Electronic ISSN: 1746-160X
DOI: https://doi.org/10.1186/1746-160X-3-29

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2007

Prospects of micromass culture technology in tissue engineering

The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension

Lack of association between celiac disease and dental enamel hypoplasia in a case-control study from an Italian central region

Pneumatized superior turbinate as a cause of headache

Exclusion of known gene for enamel development in two Brazilian families with amelogenesis imperfecta

Short-term effects of amelogenin gene splice products A+4 and A-4 implanted in the exposed rat molar pulp