Background
Although there is a growing body of evidence to document the safety and efficacy of
operative treatment of carotid stenosis, surgical indications for elongation and kinking
of the internal carotid artery remain controversial. The goal of this study was to
evaluate the efficacy of surgical correction of internal carotid artery kinking in
patients with persistent hemispheric symptoms despite antiplatelet therapy.
Methods
A consecutive series of 81 patients (mean age, 64 years) underwent 83 surgical procedures
to correct kinking of the internal carotid artery either by shortening and reimplanting
the vessel on the common carotid artery, inserting a bypass graft, or transposing
the vessel onto the external carotid artery. Mean follow-up was 56 months (range,
15-135 months). Study endpoints were 30-day mortality and any stroke occurring during
follow-up.
Results
No postoperative death was observed. The postoperative stroke rate was 1%. Primary
patency, freedom from neurologic symptoms, and late survival at 5 years (x ± standard
deviation) were 89 ± 4.1%, 92 ± 4%, and 71 ± 6%, respectively.
Conclusions
The findings of this study indicate that surgical correction for symptomatic stenotic
kinking of the internal carotid artery is safe and effective in relieving symptoms
and preventing stroke. Operative correction should be considered as the standard treatment
for patients with symptomatic carotid kinking that does not respond to antiplatelet
therapy.
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Article info
Publication history
Published online: November 30, 2007
Accepted:
July 5,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
