[Loops and folds of the carotid and vertebral arteries: indications for surgery].

We present our results of surgical correction of non-atheromatous redundant internal carotid arteries. From 1986 until 1992, we performed 1641 endarterectomies of the internal carotid artery, and in the same time we diagnosed 49 elongations in 42 patients. In 25 cases, indication for surgery was given and reconstruction was performed by shortening of the internal carotid artery, using resection and reanastomosis associated in one third of the cases with a patch. Nineteen patients (76%) were symptomatic, four patients (16%) presented a preoperative stroke and 2 patients (8%) were asymptomatic. All the patients were neurologically monitored by the use of somatosensory evoked potentials. One patient needed an intraluminal shunt because of loss of evoked potentials. No patient died in the postoperative period. One stroke occurred, concomitantly to a thrombosis of the internal carotid artery, but with totally reversible clinical symptoms after reoperation. We noted one transient ischaemic attack. We recommend operative treatment in symptomatic patients or when the stenosis is higher than 60%. A stenosis under 60% should be operated in the case of a contralateral occlusion. We propose a classification of redundant arteries based on the importance of the stenosis. The exact assessment of the stenosis is the determining factor in the diagnosis and is of primordial importance when indicating surgery.