Carotid Dolichoarteriopathies: A Comprehensive Overview
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i1.3697
Abstract
Carotid dolichoarteriopathies (CDA) represent a group of morphological abnormalities, with changes in the geometry and tortuosity of the carotid arteries. They were described in 1925 for the first time and were classified in three types according to the angle of torsion, in tortuosity (angle > 90°), coiling (S-shaped curve or loop) and kinking (angle < 90°). The pathophysiology of CDA is controversial and includes congenital mechanisms, genetic factors, connective tissue diseases, acquired mechanisms which can be associated with but not dependent on cardiovascular risk factors, and anomalies of the cervical spine. CDA have been associated with different cardiovascular and cerebrovascular events secondary to hemodynamic abnormalities, thromboembolism and cerebrovascular insufficiency and ischemia. However, the evidence is limited and for some authors they are more of a curiosity than a real predictor of ischemic events. Other studies support the clinical value of the diagnosis and follow-up of CDA and their understanding not only by internists, cardiologists and neurologists, but also by surgeons and otolaryngologists. Several authors proposed different therapeutic strategies to correct CDA, including surgical procedures. However, the indications and management approaches are controversial, and further randomized, multicenter, prospective studies are required to determine the most appropriate course of action. Until then, imaging techniques remain the basis for the etiologic diagnosis of cerebrovascular adverse events when all other causes have been excluded, and close clinical monitoring and follow-up of patients remain key strategies for the prevention of secondary events.
Keywords
dolichoarteriopathies; tortuosity; carotid arteries; vessel abnormalities; cerebrovascular disease; cardiovascular risk factors
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[2] Beigelman RL, Izaguirre AM, Azzato F, Milei J. Carotid Artery - Pathology, Plaque Structure - Relationship between Histological Assessment, Color Doppler Ultrasonography and Magnetic Resonance Imaging - Dolichoarteriopathies - Barorreceptors. In: Rezzani R, editor. Carotid Artery Disease - From Bench to Bedside and Beyond [Internet]. London: IntechOpen; 2014. doi: 10.5772/57157
[3] The global burden of disease: 2004 update. World Health Organization (WHO) Press; 2008. http://www.nhlbi.nih.gov/health/health-topics/topics/catd/[Online]
[4] Goldman L, Shafer A. Goldman-Cecil: internal medicine, 25° edition, Ed. Elsevier, 2016.
[5] Dilba K, van Dam-Nolen DHK, Crombag GAJC, van der Kolk AG, Koudstaal PJ, Nederkoorn PJ, et al. Dolichoarteriopathies of the extracranial internal carotid artery: The Plaque At RISK study. Eur J Neurol 2021;28:3133-8. doi: 10.1111/ene.14982
[6] Khasiyev F, Gutierrez J. Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk. J Neuroimaging. 2021;31:251-60. doi: 10.1111/jon.12815
[7] Kelly AB. Tortuosity of the internal carotid in relation to the pharynx. J Laring 1925;40:15-20. doi: 10.1177%2F003591572401700607
[8] Weibel J, Fields WS. Tortuosity, coiling and kinking of the internal carotid artery. Etiology and radiographic anatomy. Neurology.1965;15:7-18. doi: 10.1212/wnl.15.1.7
[9] Metz H, Murray-Leslie RM, Bannister RG, Bull JW, Marshall J. Kinking of the internal carotid artery. Lancet. 1961;1:424-6. doi: 10.1016/s0140-6736(61)90004-6
[10] Verlato F, Camporese G, Rocco S, Salmistraro G, Signorini GP. Carotid kinks relationship to atherosclerosis and cerebral ischemia. J Vasc Surg. 2000;32:293-8. doi: 10.1067/mva.2000.106953
[11] Ghilardi G, De Monti M, Longhi F, Trimarchi S, Bortolani E. Prevalenza del kinking carotideo in unapopolazioneresidente. Risultatiparzialidelprogramma OPI (ObiettivoPrevenzione Ictus) [Prevalence of carotid kinking in a resident population. Partial results of the OPI (Objective Prevention of Ictus)]. Minerva Cardioangiol. 1993;41:129-32.
[12] Balevi M. Dolicho-Arteriopathies (Kinking, Coiling, Tortuosity) of the Carotid Arteries: A Study by Magnetic Resonance Angiography. Int J Neck Head Surg, 2020;11:50-4. doi: 10.5005/jp-journals-10001-1405
[13] Valvano A, Bosso G, Apuzzi V, Mercurio V, Di Simone V, Panicara V, et al. Long-term follow-up in high risk hypertensive patients with carotid dolicoarteriopathies. Int Angiol. 2020;39:24-8. doi: 10.23736/S0392-9590.19.04229-9
[14] Bertulli L, Robert T. Embryological development of the human cranio-facial arterial system: a pictorial review. Surg Radiol Anat. 2021;43:961-73. doi: 10.1007/s00276-021-02684-y
[15] Carlson BM. Basic Embryology by Patten. 5th edition, Mexico. McGraw - Hill, 1990.
[16] Dungan DH, Heiserman JE. The carotid artery: embryology, normal anatomy, and physiology. Neuroimaging Clin N Am. 1996;6:789-99.
[17] Huber P: Cerebral Angiography, ed 2. New York, Thieme Medical Publishers, 1982.
[18] Vitek JJ, Reaves P. Thoracic bifurcation of the common carotid artery. Neuroradiology. 1973;5:133-9. doi: 10.1007/BF00341527
[19] Lie TA: Congenital Anomalies of the Carotid Arteries: An Angiographic Study and a Review of the Literature. Amsterdam, Excerpta Medica, 1968.
[20] Cairney J. Tortuosity of the Cervical Segment of the Internal Carotid Artery. J Anat 1924;59:87-96.
[21] Harrison J, Dávalos P. Cerebral ischemia. Arch Surg 1962; 84:109-12.
[22] Voevoda MI, Kulikov IV, Maksimov VN, Smirnova IuV. Association of Sp4 gene polymorphism with pathological tortuosity of internal carotid arteries. Kardiologiia. 2009;49:46-9.
[23] Zaidi SH, Peltekova V, Meyer S, Lindinger A, Paterson AD, Tsui LC, et al. A family exhibiting arterial tortuosity syndrome displays homozygosity for markers in the arterial tortuosity locus at chromosome 20q13. Clin Genet 2005;67:183-8. doi: 10.1111/j.1399-0004.2004.00391.x
[24] Arslan Y, Arslan IB, Pekçevik Y, Sener U, Köse S, Zorlu Y. Matrix Metalloproteinase Levels in Cervical and Intracranial Carotid Dolichoarteriopathies. J Stroke Cerebrovasc Dis 2016;25:2153-8. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.028
[25] Foiadelli T, Ippolito R, Corbetta R, Simoncelli AM, Amariti R, Licari A, et al. Clinical variability in children with dolichoarteriopathies of the internal carotid artery. Childs Nerv Syst 2020;36:621-8. doi: 10.1007/s00381-019-04395-7
[26] Welby JP, Kim ST, Carr CM, Lehman VT, Rydberg CH, Wald JT, et al. Carotid Artery Tortuosity Is Associated with Connective Tissue Diseases. AJNR Am J Neuroradiol 2019;40:1738-43. doi: 10.3174/ajnr.A6218
[27] Paltseva EM, Oskolkova SA, Polyakova VO, Krylova YS, Ivanova AG, Abramyan AV, et al. The structure of the internal carotid artery wall in pathological tortuosity. Arkh Patol 2015;77:3-8. Russian. https://doi.og/10.17116/patol20157753-8
[28] Ballotta E, Thiene G, Baracchini C, Ermani M, Militello C, Da Giau G, et al. Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: a prospective randomized clinical study. J Vasc Surg 2005;42:838-46; discussion 846. doi: 10.1016/j.jvs.2005.07.034
[29] Sethi SS, Lau JF, Godbold J, Gustavson S, Olin JW. The S curve: a novel morphological finding in the internal carotid artery in patients with fibromuscular dysplasia. Vasc Med 2014;19:356-62. doi: 10.1177/1358863X14547122
[30] Ballotta E, Da Giau G, Bottio T. Elongation of the internal carotid artery and abdominal aortic aneurysm: is there a relationship? J Cardiovasc Surg (Torino). 1999;40:21-6.
[31] Etheredge SN, Effeney DJ, Ehrenfeld WK. Symptomatic extrinsic compression of the cervical carotid artery. Arch Neurol 1984;41:672-3. doi: 10.1001/archneur.1984.04210080084020
[32] Del Corso L, Moruzzo D, Conte B, Agelli M, Romanelli AM, Pastine F, et al. Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging? Angiology 1998;49:361-71. doi: 10.1177/000331979804900505
[33] Pancera P, Ribul M, Presciuttini B, Lechi A. Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension? J Intern Med 2000;248:7-12. doi: 10.1046/j.1365-2796.2000.00611.x
[34] Oliviero U, Cocozza M, Picano T, Policino S, Russo N, Fazzio S, et al. Prevalence of carotid kinking and coiling in a population at risk. Vasc Surg 1997;31:43-9. doi: 10.1177/153857449703100106
[35] Wang HF, Wang DM, Wang JJ, Wang LJ, Lu J, Qi P, et al. Extracranial Internal Carotid Artery Tortuosity and Body Mass Index. Front Neurol. 2017;8:508. doi: 10.3389/fneur.2017.00508
[36] Dilba K, van Dam-Nolen DHK, Crombag GAJC, van der Kolk AG, Koudstaal PJ, Nederkoorn PJ, et al. Dolichoarteriopathies of the extracranial internal carotid artery: The Plaque At RISK study. Eur J Neurol 2021;28:3133-8. doi: 10.1111/ene.14982
[37] Derubertis BG, Hynecek RL, Kent KC, Faries PL. Carotid tortuosity in patients with prior cervical radiation: increased technical challenge during carotid stenting. Vasc Endovascular Surg. 2011;45:619-26. doi: 10.1177/1538574411408745
[38] Saba L, Argiolas GM, Sumer S, Siotto P, Raz E, Sanfilippo R, et al. Association between internal carotid artery dissection and arterial tortuosity. Neuroradiology 2015;57:149-53. doi: 10.1007/s00234-014-1436-x
[39] Barbour PJ, Castaldo JE, Rae-Grant AD, Gee W, Reed JF 3rd, Jenny D, et al. Internal carotid artery redundancy is significantly associated with dissection. Stroke. 1994;25:1201-6. doi: 10.1161/01.str.25.6.1201
[40] Yu J, Qu L, Xu B, Wang S, Li C, Xu X, et al. Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review. Int J Med Sci. 2017;14:772-84. doi: 10.7150/ijms.19229
[41] Di Pino L, Franchina AG, Costa S, Gangi S, Strano F, Ragusa M, et al. Prevalence and morphological changes of carotid kinking and coiling in growth: an echo-color Doppler study of 2856 subjects between aged 0 to 96 years. Int J Cardiovasc Imaging. 2021;37:479-84. doi: 10.1007/s10554-020-02014-0
[42] Uchino A, Kohyama S. Long segment dolichoectasia of the right internal carotid artery diagnosed by CT angiography. Radiol Case Rep. 2019;14:1084-7. doi: 10.1016/j.radcr.2019.06.013
[43] Mamedov FR, Arutiunov NV, Usachev DIu, Lukshin VA, Beliaev AIu, Mel'nikova-Pitskhelauri TV, et al. Neuroradiological diagnostics of atherosclerotic lesions and kinking of the carotid arteries in determination of indications to surgical treatment. Zh Vopr Neirokhir Im N N Burdenko. 2011;75:3-10.
[44] Nagata T, Masumoto K, Hayashi Y, Watanabe Y, Kato Y, Katou F. Three-dimensional computed tomographic analysis of variations of the carotid artery. J Craniomaxillofac Surg. 2016;44:734-42. doi: 10.1016/j.jcms.2016.02.011
[45] KazakovIu I, Ivanova OV, Pospelova AM, Vardak A. Diagnostic peculiarities, surgical policy, and efficacy of reconstructive operations in pathological tortuosity of internal carotid arteries. Angiol Sosud Khir. 2015;21:153-7.
[46] Tomiya Y, Chiba S, Moriyama H, Kikuchi Y, Ohta M. Eighteen cases of tortuosity of the internal carotid--usefulness of MR-angiography in diagnosis. Nihon Jibiinkoka Gakkai Kaiho. 1995;98:1367-72. Japanese. doi: 10.3950/jibiinkoka.98.1367
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