THE ELONGATION OF THE INTERNAL CAROTID-ARTERY - EARLY AND LONG-TERM RESULTS OF PATIENTS HAVING SURGERY COMPARED WITH UNOPERATED CONTROLS

The purposes of this study are to (1) demonstrate the association of e longations of the internal carotid artery (ICA), that is, kinking, coi ling, tortuousity, and angulation, and the neurologic symptoms with hi gh stroke risk; (2) compare the results of the surgical treatment vers us the medical treatment alone; (3) contribute to the knowledge of the natural history of these anatomical particularities. From January 199 2 to December 1994, 113 patients with ICA kinking, coiling, tortuousit y, and angulation were randomized either to surgery (group I, n=55) or not (group II, n=58). Patients, who presented a carotid hemodynamical ly significant lesion (>60%) at the origin and associated distal elong ation were excluded. The groups were comparable with regard to sex, ag e, risk factors for atherosclerosis, associated diseases, symptoms and anatomic feature of the contralateral ICA. Follow-up was obtained in all patients: it consisted of clinical evaluation and Duplex scan cont rol at 3-month intervals during the follow-up period (6-36 months; ave rage, 23), Histologic specimens were obtained in all surgically treate d arteries. Early results were excellent: in group I, no patient died. no patient presented major or minor stroke. Only one patient had an i mmediate transient ischemic attack (TIA) which spontaneously recovered within 24 hours. All symptomatic patients examined the complete disap pearance of clinical signs. There were no late deaths due to stroke an d no late major or minor neurologic deficit occurred. All reconstructe d ICAs were patent. In group II, three patients experienced a major st roke with hemiplegia due to ICA occlusion. Most of the symptomatic pat ients (37) of group II remained stable, while seven of them had worsen ing of symptoms and were referred for surgery. To conclude, all surgic ally treated patients had the complete relief of preoperative neurolog ic symptoms; none of the medically treated patients had an improvement . Although there was no statistically significant difference between t he two groups with regard to stroke risk, three medically treated pati ents progressed to total occlusion. This suggests that kinking, coilin g, tortuousity, and angulations of the ICA are not merely an anatomic curiosity but a potentially disabling, even fatal condition.