Clinical manifestations and diagnosis of pathological deformity of the internal carotid artery.

Objective: to study clinical and morphological aspects of pathologically deformed pathological deformity of the internal carotid artery.

Methods: the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (1СA), who underwent a total of 166 reconstructive operations.

Results: more than half (58%) of the patients were operated on for 1С A kinking, 27% for coiling and only 15% were found to have C- and S-shape tortuosity. The patients were predominantly women, with a male-to-female ratio of 1:1.6 (Р<0.01). The majority of the patients (61%) were operated on at the age varying from 51 to 70 years (P<0.01). Patients under 40 years appeared to more often (92%) suffer bilateral lesions (P<0.01). 56% of patients had a history of acute cerebral circulation impairment (P<0.05). A symptom-free course of the disease was more frequently encountered in unilateral lesions (P<0.01). Patients under 30 years were more often operated on at the pre-stroke stage of the disease (P<0.05). Patients with kinking of the internal carotid artery had a significantly higher risk (63%) of acute cerebral ischaemia (p<0.01). Arterial hypertension was revealed in 74% of patients. Incidence of acute cerebral ischaemia events was significantly higher in hypertensive patients (P<0.01). Pronounced haemodynamic impairments (bloodflow turbulence) were significantly more often (92%) detected in patients with kinking of the internal carotid artery (P<0.05).

Conclusion: patients with clinical signs of cerebrovascular insufficiency, being relatively young and having concomitant arterial hypertension even with no objective signs of a stenotic lesion of coronary arteries should be referred to duplex scanning of brachiocephalic arteries in order to verify a pathological deformity of the internal carotid artery at the pre-stroke stage of the disease. An algorithm of examination including duplex scanning of brachiocephalic arteries and comprehensive magnetic resonance imaging made it possible to in short time obtain the in-depth information about the anatomical and topographical peculiarities of the pathological deformity of the internal carotid artery and to assess its haemodynamic significance, which in turn makes it possible to clearly and timely determine the treatment policy for the patient concerned.