COILED/KINKED  CAROTID ARTERY

A

This 70 yr. old male presented with recurrent weakness of the (R) arm and leg lasting less than one hour.He had a previous stroke and was known to have a totally occleded (R) carotid artery.Duplex scan confirmed the presence of an occluded (R) carotid artery  but more importantly a precritical stenosis(L) (>90%)supported by   an  elevated peak systolic velocity,diastolic and systolic velocity ratios and a grossly elevated end diastolic velocity.The ultrasound is rermarkable in showing the "doughnut effect" of  a complete coil or 360 degree  redundant vessel(A &B)
   Past history included hypertension and a previosly resected AAA lost to follow up for  three years.
   A routine MR angio was done as per our proctol  substituting for the time honored standard cerebral angiogram.This confirmed the occlusion of the (R) carotid artery  as well as as crossover from (L) to (R) in ther circle of Willis associated with the  complete 360 degree coiling seen on the duplex(C&D)
  The patient was brought to the  operating room and given the benefit of a  a carotid endartectomy, resection  of the aneurysmal / coiled segment with reimplantation of the distal internal carotid on the endartectomized carotid bulb.The vessel had beome  thinned and aneurysmal  prior  to straightening distally.

  True coils or kinking are not that uncommon (5-15% of cerebral angiograms) .Most are likely asymptomatic.They  prove problematic when symptoms occur  when the degree of stenosis does  not have hemodynamic significance.Often the presenting complaint of cerebral vascular insufficiency occurs witn rotational movemt of the neck.Most are often asssociated with the standard  disease at the carotid bifurcation.Surgical treatment often lends itself to the eversion endarterectomy technique with vessel shortening.

B

C

D