La Barbera G, La Marca G, Martino A, Lo Verde R, Valentino F, Lipari D, Peri G, Cappello F, Valentino B
Department of Vascular Surgery, G. Di Cristina Civic Hospital, Palermo, Italy.
Surg Radiol Anat. 2006 Dec;28(6):573-80. doi: 10.1007/s00276-006-0149-1. Epub 2006 Nov 22.
Morphological anomalies of the extracranial internal carotid artery (ICA) cause symptomatic cerebrovascular insufficiency in 4-16% of the cases. The aim of the present study is to evaluate macroscopic and microscopic features of a group of extracranial ICA anomalies, specifically kinking, coiling, and tortuosity, eventually affecting the surgical approach.
From January 2003 to December 2005, 10 out of 169 (6%) revascularized patients (pts) were operated upon because of an ICA anomaly. They were all but two symptomatics. Seven pts were treated by ICA transection and end-to-side reimplantation of the ICA at the level of the carotid bulb; three pts were treated by ICA resection and end-to-end anastomosis. In all the cases a segment of ICA was resected; in three cases one more segment was also obtained from a common carotid artery (CCA) and these specimens were histologically examined. Patients were followed-up through a 3-year period.
No pts died and none suffered of neurologic events. Duplex scan and arteriographic postoperative control showed the correct surgical reconstruction. Matching preoperative clinical findings with presence or absence of significant atherosclerotic stenotic lesion, we found out a positive cerebral CT in one pt (20%) in both groups; fluent neurological deficit was preeminent in pts with pure ICA anomalies (40% vs. 0%) (P = 0.2); pts with pure ICA anomalies were significantly younger than 65 years old (80% vs. 0%) (P = 0.03) and males were more involved by pure ICA anomalies (60% vs. 40%) (P = 0.1). The histological examination of ICA specimens showed a reduction of elastic fibers and muscular cells with a compensative increase of connective fibers.
At our knowledge this is the first study focused on ICA anomalies like kinking, coiling, and tortuosity, comparing histologic features of CCA and ICA specimens coming from the same affected carotid axis. Our results, although preliminary, show elastic and muscular tissue substituted by loose connective tissue, configuring a metaplasia of tunica media limited to the ICA. Our hypothesis is that extracranial ICA, being a segment of transition between an elastic vessel (CCA) and a muscular vessel (intracranial ICA), is particularly subject to metaplastic transformation, analogously to other transition zones in human body. Our purpose is now to confirm by ultrastructural and molecular biology techniques, in a wider series, the presence of this metaplasia, since this could condition also the revascularization techniques.
颅外颈内动脉（ICA）的形态异常在4% - 16%的病例中会导致有症状的脑血管供血不足。本研究的目的是评估一组颅外ICA异常的宏观和微观特征，特别是扭结、盘绕和迂曲，这些最终会影响手术入路。
从2003年1月至2005年12月，169例接受血管重建的患者中有10例（6%）因ICA异常接受了手术。除2例患者外均有症状。7例患者接受了ICA横断并在颈动脉球水平进行ICA端侧再植入；3例患者接受了ICA切除和端端吻合。所有病例均切除了一段ICA；3例病例还从颈总动脉（CCA）获取了一段额外的标本并进行了组织学检查。对患者进行了为期3年的随访。
无患者死亡，也无患者发生神经事件。双功超声扫描和术后血管造影检查显示手术重建正确。将术前临床发现与是否存在显著的动脉粥样硬化狭窄病变进行匹配，我们发现在两组中均有1例患者（20%）脑CT呈阳性；纯ICA异常患者中流利性神经功能缺损更为突出（40%对0%）（P = 0.2）；纯ICA异常患者明显小于65岁（80%对0%）（P = 0.03），且男性受纯ICA异常影响更多（60%对40%）（P = 0.1）。ICA标本的组织学检查显示弹性纤维和肌细胞减少，结缔组织纤维代偿性增加。
据我们所知，这是第一项聚焦于ICA扭结、盘绕和迂曲等异常的研究，比较了来自同一受影响颈动脉轴的CCA和ICA标本的组织学特征。我们的结果虽然是初步的，但显示弹性和肌肉组织被疏松结缔组织替代，形成了仅限于ICA的中膜化生。我们的假设是，颅外ICA作为弹性血管（CCA）和肌性血管（颅内ICA）之间的过渡段，特别容易发生化生转变，类似于人体中的其他过渡区。我们现在的目的是通过超微结构和分子生物学技术在更广泛的系列研究中证实这种化生的存在，因为这也可能影响血管重建技术。
