Radonic V, Baric D, Giunio L, Buća A, Sapunar D, Marović A
Department of Surgery, Clinical Hospital, Split, Croatia.
J Cardiovasc Surg (Torino). 1998 Oct;39(5):557-63.
The aim of this study was to provide information on the diagnosis and treatment of kinking -- bends in the extracranial internal carotid artery (KICA), a rate but major and treatable cause of cerebral ischemia.
A retrospective review of the seven-year experience in Split Hospital. ESSENTIAL DATA: The role of the surgical correction of carotid artery kinking has not yet been precisely defined.
Of the 86 carotid revascularization operations performed in 76 patients from 1988 to 1994, 21 (29%) patients underwent surgery owing to symptomatic kinking of the internal carotid artery. This group included 8 females and 13 males with a mean age of 57.3+/-5.5 years (range 44-70). Symptoms included cerebrovascular insults in 43%, hemispheric transient ischemic attacks in 33%, reversible ischemic neurological deficit in 24% of patients. The diagnosis was made using two-dimensional ultrasound scan and Doppler, computerised tomography and angiographic evaluation. Two methods were used: the elimination of kinking and graft of the internal artery onto the common carotid artery with excision of the kinked section of the artery and end-to-end anastomosis. Dense fibrous tissues around the kinked artery were removed and the artery was freed along its entire course. The anomalous relationship between the internal carotid artery, occipital artery and hypoglossal nerve was corrected.
After surgery seventeen patients fully recovered without neurological complications. One patient died, one patient suffered permanent neurological deficit, two suffered from transient ischemic attacks.
Anatomic reconstruction together with the correction and elimination of the affected segments of the carotid artery may prevent progressive cerebrovascular symptoms and is associated with a low morbidity and mortality rate.
本研究旨在提供有关颅外颈内动脉扭结（KICA）的诊断和治疗信息，KICA是导致脑缺血的一个少见但主要且可治疗的病因。
对斯普利特医院七年经验的回顾性研究。基本数据：颈动脉扭结手术矫正的作用尚未明确界定。
1988年至1994年对76例患者进行了86次颈动脉血运重建手术，其中21例（29%）患者因颈内动脉症状性扭结接受手术。该组包括8名女性和13名男性，平均年龄57.3±5.5岁（范围44 - 70岁）。症状包括43%的患者出现脑血管损伤，33%的患者出现半球短暂性脑缺血发作，24%的患者出现可逆性缺血性神经功能缺损。诊断采用二维超声扫描和多普勒检查、计算机断层扫描及血管造影评估。采用了两种方法：消除扭结以及将颈内动脉移植到颈总动脉上，同时切除动脉扭结段并进行端端吻合。去除扭结动脉周围的致密纤维组织，并沿动脉全程游离动脉。纠正颈内动脉、枕动脉和舌下神经之间的异常关系。
术后17例患者完全康复，无神经并发症。1例患者死亡，1例患者出现永久性神经功能缺损，2例患者出现短暂性脑缺血发作。
颈动脉病变节段的解剖重建以及矫正和消除可预防进行性脑血管症状，且发病率和死亡率较低。
