Kinking and coiling of internal carotid artery with and without associated stenosis. Surgical considerations and long-term follow-up.

Although incidence of coiling and kinking of internal carotid artery has been estimated to be from 10% to 16% in general population, respective clinical significance still remains the ground of controversy. Cerebrovascular hemodynamic changes mainly from kinking and in a lesser degree from coiling, have been documented with oculoplethysmographic and angiographic differences, accompanying positional changes of the head. The opposite view however, that similar variations represent a benign and incidental finding, has been also expressed. In a 24-year period ending March 1994 and with case material of carotid artery surgery totalling 1123 operations, 59 patients with different type of kinking and coiling underwent surgical reconstruction. There were 31 patients with kinking, 14 with coiling and 14 (22%) with associated occlusive process at the origin of the internal carotid artery. In the later, three cases with abdominal aneurysm are also included. Apart from angiographic evidence, particular value was ascribed to symptomatology and ophthalmodynamographic changes, produced in different head positions. Operative indications with the exception of four cases, were determined on the basis of symptoms compatible with brain ischemia. In all instances of isolated kinking and coiling, straightening was obtained by segmental resection of the common carotid artery and end to end anastomosis. In cases with associated occlusion, transection of internal carotid artery at its origin and re-implantation in the lateral aspect of the common carotid, was the remedy of choice.