Alternative surgery for the kinked internal carotid artery.
BACKGROUND
Carotid kinking can either be a source of emboli or it may cause cerebral ischemia during head/neck rotation. Surgical techniques to correct the kink usually employ carotid cross-clamping and kink resection. In selected cases the authors used simple kink straightening and fixation. The patients treated by this method were evaluated.


METHODS
Total of 42 operations in 40 patients were performed from 1984 through 1998. Mean age was 56 years, male:female ratio 1:1. Patients presented with either TIAs (n=26), minor stroke (n=13) or were asymptomatic (n=3). There were 2 distinct groups of patients. Group I. were the patients with kinking only (n=28), Group II. the patients in whom the kink was seen at the end of regular carotid stenosis. In all patients the kink was dissected free, straightened and fixed by several stitches. In the Group II. this manoeuvre followed standard carotid micro-endarterectomy.


RESULTS
Mean follow-up is 4,8 years (1-15). There was no morbidity, no mortality. Only 1 patient suffered several TIAs in the 6 months period after surgery. All patients are alive and symptom free.


CONCLUSIONS
In lesser kinks the simple surgical technique without cross-clamping is effective, easy and complication free.
Benes
V
V
Department of Neurosurgery, Prague, Czech Republic.
Mohapl
M
M
D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002340:Carotid Artery Diseases / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000601:surgery*; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome