COILING AND KINKING OF VERTEBRAL AND CARO TID ARTERIES - INDICATIONS FOR SURGERY

Tortuous variants of the carotid or vertebral morphology are apparent on 10 to 43 % of angiograms. It is probable that the incidence of thes e anomalies is lower in the normal population. Rarely, their etiology is congenital explaining the existence of some pediatric cases. The et iology of most cases is acquired and linked with hypertension, atherom a and aging. Basically consisting of an excess of length of the common or the internal carotid artery, the tortuosity may take the form of s imple or multiple kinking, coiling or looping. isolated, these anomali es are asymptomatic in a large majority of the cases. However hemisphe ric, vertebrobasilar or ocular ischemic symptoms may be caused by them through a thromboembolic or hemodynamic mechanism. Moreover, given th eir frequent association with atherosclerotic occlusive lesions, their participation in the production of ischemic symptoms is not easy to d etermine. Although not yet investigated by prospective randomized stud ies, symptomatic isolated of kinking or coiling of cerebral arteries a re amenable to surgical revascularization in order to prevent stroke o r blindness. Besides, the endarterectomy of atherosclerotic occlusive lesions of tortuous carotids requires a technical adaptation.