Year 2015 Vol. 23 No 6

GENERAL & SPECIAL SURGERY

N. TORMA 1, I.I. KOPOLOVETS 2, V. SIHOTSKÝ 3, 4, M. KUBÍKOVÁ 3, 4,M. FRANKOVIČOVÁ 3, 4

SURGICAL TREATMENT OF ATHEROSCLEROTIC STENOSIS OF CAROTID ARTERIES IN COMBINATION WITH PATHOLOGICAL TORTUOSITY OF THE INTERNAL CAROTID ARTERY FOR ISCHEMIC STROKE PREVENTION

Vascular Center "IMEA ", Kosice1,
The Slovak Republic
HSEE "Uzhgorod National University"2,
Ukraine
East Slovak Institute of Cardiovascular Diseases "VUSCH"3,
P.I. Safarik University, medical faculty, Kosice4,
The Slovak Republic

Objectives. To investigate the results of surgical treatment of patients with pathological tortuosity of the internal carotid artery.
Methods. The results of surgical treatment of patients (n=97) with pathological tortuosity (PT) of internal carotid artery (ICA) in combination with atherosclerotic stenosis have been presented. The results of treatment depending on the degree of deformation, atherosclerotic damage localization and clinical symptomatology have been analyzed. The patients were divided into 3 groups depending on etiopathogenetical factors, clinical manifestations and patients examination results. In those groups the patients didnt differ in their age and sex characteristics.
Group I (n=18) the patients with pathological tortuosity of internal carotid artery (PT ICA) without atherosclerotic stenosis of carotid arteries;
Group II (n=36) the patients with pathological tortuosity of internal carotid artery and asymptomatic atherosclerotic stenosis;
Group III (n=43) the patients with pathological tortuosity of internal carotid artery and symptomatic atherosclerotic stenosis.
Results. No reliable statistic difference was revealed in comparison with the surgical treatment results of CA atherosclerotic stenosis in combination with ICA pathological tortuosity in the groups represented in the investigation (≥0,05). The optimal method of treatment of ICA pathological tortuosity is considered to be a surgical reconstruction. Surgical tactics means resection of excessive ICA length with further reimplantation or transposition, and in case of atherosclerotic stenosis performing eversion endarterectomy.
In group I the patients (n=11; 61,1%) showed specific symptoms of cerebral ischemic regression typical for PT ICA; in the group II (n=21; 58,3%); in group III (n=16; 37,2%).
Conclusion. Surgical correction in symptomatic patients is a successful method of treatment of cerebral insufficiency and ischemic stroke prevention. Early good and satisfactory results of surgical treatment of pathological tortuosity of the internal carotid artery accounted for 100% in group I; 97,2% in group II and 95,3% in group III.

Keywords: carotid arteries atherosclerosis, kinking, coiling, ischemic stroke, etiopathogenetical factors, cerebral insufficiency, surgical treatment
p. 631-636 of the original issue
References
  1. Pokrovskii AV, Beloiartsev DF, Adyrkhaev ZA, Timina IE, Losik IA. Otdalennye rezul'taty rekonstruktivnykh operatsii pri patologicheskoi deformatsii vnutrennei sonnoi arterii [Long-term results of reconstructive surgery for pathological deformation of the internal carotid artery]. Angiologiia i Sosud Khirurgiia. 2012;(18)1:92-104.
  2. Beigelman R, Izaguirre AM, Robles M, Grana D, Ambrosio G, Milei J. Kinking of carotid arteries is not a mechanism of cerebral ischemia: A functional evaluation by Doppler echography International angiology: J of Intern Union of Angiology. 2011;30(4):342-48.
  3. Rodin IV. Gemodinamicheskie vzgliady na patologicheskuiu izvitost' sonnykh arterii [Hemodynamic views on pathological tortuosity of the carotid arteries]. Novoe v Angiologii Sosud Khirurgii. 2005;(2):150-52.
  4. Ballotta E, Thiene G , Baracchini C, Ermani M, Militello C, Giuseppe Da Giau, Barbon B, Angelini A. 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.
  5. Molčan T. Chirurgická liečba cerebrovaskulárnej insuficiencie Via Pract. 2006;3(5):234-38.
  6. Kalitko IM, VI, Kovalenko NIu, Berezova IV, Kazantseva, V.V. Shebriakov, V.P. Kochubei, T.N. Beliakova Diagnostika i khirurgicheskoe lechenie patologicheskoi izvitosti vnutrennikh sonnykh arterii [Diagnosis and surgical treatment of pathological tortuosity of the internal carotid arteries]. Angiologiia i Sosud Khirurgiia. 2007;(13)2:89-94.
  7. Stanciulescu R, Ispas A, Filipoiu F, Bordei P, Galaman L, La Marca G. Anatomical variations of the carotid arteries: kinking, coiling, and tortuosity. Anatomical and functional considerations. IJAE. 2010;(115):161-68
  8. Radak Dj. Babić S, Tanasković S, Matić P, Sotirović V. Are the carotid kinking and coiling underestimated entities? Vojnosanitetski pregled. Military-medical and pharmaceutical review. 2012;69(7):616-19. DOI: 10.2298/VSP110722001R.
  9. Mumoli N, Marco C. Asymptomatic carotid kinking. Circulation Journal. 2008;72(4);682-83.
  10. Rusin V, Korsak VV, Butsko ЄS. Sindrom obkradannia pri patolog sudin dugi aorti [Steal syndrome in the pathology of the aortic arch vessels]. Uzhgorod, Ukraina: Karpati; 2011. 208 p.
  11. Togay-Isikay' C, Kim J, Betterman K, Andrews C, Meads D, Tesh P, Tegeler C, Oztuna D. Carotid artery tortuosity, kinking, coiling : stroke risk factor, marker, or curiosity? Acta Neurol. Belg. 2005;(105):68-72.
  12. Poorthuis MH, Brand EC, Toorop RJ, Moll FL, de Borst GJ. Posterior transverse plication of the internal carotid artery to correct for kinking. J Vasc Surg. 2014 Apr; 59(4): 968-77.
  13. YK, Zhong T, Li L, Wang J, Chen Y, Zhou H. Significant Association between Carotid Artery Kinking and Leukoaraiosis in Middle-Aged and Elderly Chinese Patients. Journal of Stroke and Cerebrovascular Diseases. 2015;24(5):1025-1031. doi: 10.1016/j.jstrokecerebrovasdis.2014.12.030.
Address for correspondence:
88000, Uzhgorod, Ukraine,
ul. Universitetskaya d.10,
VGUZ "Uzhgorodskiy natsionalnyiy universitet",
tel.mob.: 38050558-82-11,
e-mail: i.kopolovets@gmail.com,
Kopolovets Ivan Ivanovich
Information about the authors:
Torma N. PhD, vascular surgeon, "IMEA ".
Kopolovets I.I. PhD, a researcher of HSEE "Uzhgorod National University".
Sihotský V. PhD, P.I. Safarik University, medical faculty, Deputy Head of the Vascular Surgery Clinic for teaching.
Kubíková M. PhD, a head of the Vascular Surgery Department, P.I. Safarik University, medical faculty.
Frankovičová M. PhD, professor, a head of the Vascular Surgery Clinic, P.I. Safarik University, medical faculty.
Contacts | ©Vitebsk State Medical University, 2007-2023