Kinking of internal carotid artery: is it a risk factor for cerebro-vascular damage in patients undergoing cardiac surgery?

The incidence of carotid artery kinking is reported from 4% to 25% in different studies. During cardiopulmonary by-pass (CPB) in cardiac surgery the hemodynamic effects related to the kinking could produce hypoperfusion especially if associated with atherosclerotic lesions of the carotid arteries. W...

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Bibliographic Details
Published inJournal of cardiovascular surgery Vol. 35; no. 4; p. 325
Main Authors Borioni, R, Garofalo, M, Actis Dato, G M, Pierri, M D, Caprara, E, Albano, P, Chiariello, L
Format Journal Article
LanguageEnglish
Published Italy 01.08.1994
Subjects
Arteriosclerosis - classification
Arteriosclerosis - complications
Arteriosclerosis - diagnosis
Arteriosclerosis - epidemiology
Arteriosclerosis - surgery
Cardiopulmonary Bypass
Carotid Artery, Internal - abnormalities
Carotid Stenosis - classification
Carotid Stenosis - complications
Carotid Stenosis - diagnosis
Carotid Stenosis - epidemiology
Carotid Stenosis - surgery
Cerebrovascular Disorders - epidemiology
Cerebrovascular Disorders - etiology
Congenital Abnormalities - classification
Congenital Abnormalities - diagnosis
Congenital Abnormalities - epidemiology
Congenital Abnormalities - surgery
Coronary Angiography
Endarterectomy, Carotid
Female
Humans
Incidence
Intraoperative Complications - epidemiology
Intraoperative Complications - etiology
Male
Middle Aged
Risk Factors
Thrombectomy
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Summary:The incidence of carotid artery kinking is reported from 4% to 25% in different studies. During cardiopulmonary by-pass (CPB) in cardiac surgery the hemodynamic effects related to the kinking could produce hypoperfusion especially if associated with atherosclerotic lesions of the carotid arteries. We report our experience of 653 patients (538 males, 115 females, mean age 58.3 years) studied by coronaroangiography and internal carotid artery duplex scanning during the period January 1991-December 1992. Thirty-seven patients (22 males, 15 females, mean age 64.9 years), revealed anomalies of the internal carotid artery classificated as tortuosity (9 patients; 24.4%), and kinking (28 patients; 75.6%). All but 4 patients underwent cardiac surgery isolated or associated with carotid thrombo-endarterectomy (TEA) with Dacron patch arterioplasty. Three patients died (8.1%), one of them from cerebrovascular accident. He was a patient who had thromboembolism from the ascending aorta but without associated atherosclerotic lesions of carotid arteries. 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 plaque producing internal carotid artery stenosis greater than 75%, we strongly suggest surgical treatment before cardiac operation.
ISSN:0021-9509