Pathological elongations of the carotid arteries: Diagnostics and surgical treatment

Pathological elongations of cervical blood vessels are relatively common, but their exact incidence in general population is still unknown. The history of intermittent symptoms of cerebrovascular insufficiency, which may be provoked by rotatory movements of the head and the neck, should raise suspicion of the presence of carotid artery redundancy. On the basis of the clinical features and modern diagnostic procedures, we can determine the hemodynamic significance of kinking and coiling. Maximal systolic velocity, measured by color duplex ultrasonography, is an important parameter for reaching the diagnosis. Arteriography, CT or classic, is reserved only for symptomatic cases of kinking and coiling. Although the largest amount of morphological information is provided by intra-arterial digital subtraction arteriography, the number of surgical decisions made on the basis of non-invasive tests has increased. Surgical reconstruction in patients with hemodynamically significant kinking/coiling ICA is a safe and effective method of ischemic stroke prevention, which relieves the symptoms of cerebral ischemia and improves cerebral perfusion.