KINKING OF INTERNAL CAROTID-ARTERY - IS IT A RISK FACTOR FOR CEREBROVASCULAR DAMAGE IN PATIENTS UNDERGOING CARDIAC-SURGERY

The incidence of carotid artery kinking is reported from 4 % to 25 % i n different studies. During cardiopulmonary by-pass (CPB) in cardiac s urgery the hemodynamic effects related to the kinking could produce hy poperfusion especially if associated with atherosclerotic lesions of t he carotid arteries. We report our experience of 653 patients (538 mal es, 115 females, mean age 58.3 years) studied by coronaroangiography a nd internal carotid artery duplex scanning during the period January 1 991-December 1992. Thirty-seven patients (22 males, 15 females, mean a ge 64.9 years), revealed anomalies of the internal carotid artery clas sificated as tortuosity (9 patients; 24.4%), and kinking (28 patients; 75.6%). All but 4 patients underwent cardiac surgery isolated or asso ciated with carotid thrombo-endarterectomy (TEA) with Dacron patch art erioplasty. Three patients died (8.1%), one of them from cerebrovascul ar accident. He was a patient who had thromboembolism from the ascendi ng aorta but without associated atherosclerotic lesions of carotid art eries. Asymptomatic isolated internal carotid artery kinking does not seem to be a risk factor for neurological complications during CPB. If carotid kinking is symptomatic and associated with atherosclerotic pl aque producing internal carotid artery stenosis greater than 75%, we s trongly suggest surgical treatment before cardiac operation.