DOI: 10.25881/20728255_2021_16_3_61

Authors

Batrashov V.A., Yudaev S.S., Zemlyanov A.V.

Pirogov National Medical and Surgical Center, Moscow

Abstract

Pathological tortuosity-elongation of the carotid arteries with the formation of kinks (so-called septal stenoses), up to complete loops at 360°. In the development of ischemic brain disorders, pathological tortuosity of the carotid arteries takes the second place after atherosclerotic lesions. Currently, there are many unsolved problems in their treatment. The etiological factors, indications for surgery, evaluation of the effectiveness and choice of tactics of surgical interventions have not been fully studied. This review presents the current aspects of etiology, classification, indications and methods of surgical interventions. Modern methods of diagnosis and evaluation of cerebral ischemia are demonstrated, data on laboratory markers of ischemia are collected, and methods of intraoperative protection of the brain in resections of tortuosity of the internal carotid arteries are shown.

Keywords: pathological tortuosity, kinking, coiling, dolichoarteriopathy, intraoperative neuromonitoring, markers of cerebral ischemia.

References

1. Suslina ZA, Varakin JuJa, Vereshhagin NV. Sosudistye zabolevanija golovnogo mozga. Moscow: MEDpress-inform; 2009. (In Russ).

2. Suslina ZA, Piradov MA. Insul’t: diagnostika, lechenie, profilaktika Moscow: MEDpress-inform; 2009. (In Russ).

3. Dadashov Sabuhi Asaf ogly, Taktika hirurgicheskogo lechenija patologicheskoj izvitosti vnutrennej sonnoj arterii. [dissertation]; Moskva; 2012. (In Russ).

4. Pal’ceva EM, Oskolkova SA, Poljakova VO, Krylova JuA, Ivanova AG, Abramjan AV. Stroenie stenki vnutrennej sonnoj arterii pri patologicheskoj izvitosti. Arhiv patologii. 2015; 77(3): 3-8 (In Russ).

5. P. Pancera M. Ribul B. Presciuttini A. Lechi. Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension? Journal of internal Medicine. 2000; 25(1): 7-12.

6. Ghilardi G, Longhi F, De Monti F, Bortolani E. Kinking carotideo ed ipertensione arteriosa. Risultati preliminari del programma OPI. Minerva Cardioangiologica. 1993; 41: 287-291.

7. Pokrovskij A.V. Klinicheskaja angiologija. Rukovodstvo dlja vrachej. Moscow: Medicina; 2004. (In Russ).

8. Pancera P. Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension? Journal of Internal Medicine. 2010; 248: 7-12.

9. Amidzic А, Naida T. Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction. Medical Archives. 2020; 74(1): 58-60.

10. Jinlu Yu, Lai Qu, Baofeng Xu, Shouchun W, Chao Li, Xan Xu, Yi Yang. Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review. International Journal Medical Sciences. 2017; 14(8): 772-784.

11. Weibel J., Fields WS. Tortuosity, coiling, and kinking of the ICA. Etiology and radiographic anatomy. Neurology. 1965; 15: 7-11.

12. Metz H, Murray-Leslie RM, Bannister RG, Bull JWD, Marshall J. Kinking of the ICA in relation to cerebrovascular disease. The lancet. 1961; 25: 424-26.

13. Amidzic А, Naida T. Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction. Medical Archives. 2020; 74(1): 58-60.

14. Nacional’nye rekomendacii po vedeniju pacientov s zabolevanijami brahiocefal’nyh arterij. Rossijskij soglasitel’nyj dokument. Moskva; 2013. (In Russ).

15. Gavrilenko AV, Kuklin AV, Khripkov AS, Abramian AV. Assessment of efficacy of reconstructive operations on carotid arteries in combination of stenosis and pathological tortuosity. Angiologia and sosudistaya hirurgiya. 2014; 20(3): 116-22. (In Russ).

16. Kazakov IuI, Ivanova OV, Pospelova AM, Vardak A. Diagnostic peculiarities, surgical policy, and efficacy of reconstructive operations in pathological tortuosity of internal carotid arteries. Angiologiya and sosudistaya hirurgiya. 2015; 21(4): 153-7. (In Russ).

17. Gavrilenko AV, Abramian AV, Kuklin AV. Comparative analysis of the outcomes of surgical and conservative treatment of patients with pathological kinking of carotid arteries. Angiologia and sosudistaya hirurgiya. 2012; 18(4): 93-9. (In Russ).

18. Ballotta E, Thiene G, Baracchini C, Ermani M, Militello C, Da Giau G, 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. Journal of Vascular Surgery. 2005; 42(5): 838-846.

19. Riser M, Gerard J, Ribaut L. Dolichocarotide interne avec syndrome vertigineux. Revue Neurologique. 1951; 85: 145-151.

20. Belov JuV. Rukovodstvo po sosudistoj hirurgii s atlasom operativnoj tehniki. 2011: 464 р. (In Russ).

21. Illuminati G, Ricco JB, Calio FG, D’Urso A, Ceccanei G, Vietri F. The results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery. Surgery. 2008; 143: 134-139.

22. Vybor metoda hirurgicheskogo lechenija patologicheskoj izvitosti vnutrennej sonnoj arterii v sochetanii so stenozom. 109 Bjulleten’ NCSSH im. A.N.Bakuleva RAMN «Serdechno-sosudistye zabolevanija». 2014; 15(6): 138. (In Russ).

23. Dirrenberger RA, Sundt TM.Temporal profile of the healing process and effects of anticoagulation therapy. Journal of Neurosurgery. 1978; 48: 201-219.

24. Pokrovskij AV. «Klassicheskaja» karotidnaja jendarterjektomija. Angiologija i sosudistaja hirurgija. 2001; 2: 101-104. (In Russ).

25. Arutjunjan OM, Javorovskij AG, Guleshov VA, Dutikova EF, Fedulova SV, Bunjatjan AA. Primenenie nejromonitoringa na osnove jentropii dlja opredelenija gipoperfuzii golovnogo mozga pri operacijah na sonnyh arterijah. Patologija krovoobrashhenija i kardiohirurgija. 2011; 3: 51-56. (In Russ).

26. Pennekamp CW, Bots ML, Kappelle LJ, et al. The value of near-infared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review // Eur J Vasc Endovasc Surg. 2009; 38(5): 539-545.

27. Kuncevich GI, Tanashjan MM, Skrylev SI, Krotenkova MV. Intraoperacionnoe monitorirovanie mozgovogo krovotoka i sostojanie veshhestva golovnogo mozga pri otkrytyh i jendovaskuljarnyh vmeshatel’stvah v karotidnoj sisteme. Angiologija i sosudistaja hirurgija. 2011; 17(3): 43-48. (In Russ).

28. Dalman JE, Beenakkers IC, Moll FL, Leusink JA. Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion. J. Vasc Endovasc Surg. 1999; 18: 222-227.

29. Karavaev BI, Gavrilenko AV, Zolicheva NJu. Perioperacionnaja diagnostika cerebral’noj ishemii pri rekonstruktivnyh operacijah na sonnyh arterijah. Anesteziologija i reanimatologija. 1999; 5: 71-74.(In Russ).

30. Pokrovskij AV. Mozhno li izbezhat’ ishemicheskogo insul’ta s pomoshh’ju sosudistoj operacii? Hirurgija. Zhurnal im. N.I.Pirogova. 2003; 3: 1-10. (In Russ).

31. Calligaro K.D., Dougherty M.J. Сorrelation of carotid artery stump pressure and neurologic changes during 474 carotid endarterectomies performed in awake patients // J Vasc Surg. 2005; 42(4): 684-689.

32. Molochnyj VP, Makarova TE, Golovkova NF, Obuhova GG. Nejrospecificheskaja enolaza i gliofibriljarnyj kislyj protein krovi i cerebrospinal’noj zhidkosti kak marker povrezhdenija tkani mozga pri bakterial’nyh gnojnyh meningitah u detej. Dal’nevostochnyj medicinskij zhurnal. 2012; 2: 48-51. (In Russ).

33. Flierl MA, Stahel PF, Touban BM, et al. Bench-to-bedside review: Burninduced cerebral inflammation — a neglected entity. Critical Care. 2009; 13: 215–223.

34. Shaaban MА. Serum protein S100 as a marker of cerebral damage during cardiac surgery. Brit. J. of Anaesthesia. 2000; 85(2): 287-298.

35. Rigamonti A, Scandroglio M, Minicucci F, Magrin S, et al. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy. J Clin Anesth. 2005; 17(6): 426-430.

36. Krylova OV, Vorob’eva VA, Ovsjannikova OB, Solov’eva EN. Nejrospecificheskaja enolaza v diagnostike perinatal’nyh porazhenij central’noj nervnoj sistemy u nedonoshennyh detej. Pediatricheskaja farmakologija. 2010; 3: 66-70. (In Russ).

37. Burbaeva GSh. Fiziologicheski aktivnye belki mozga kak vozmozhnye markery psihicheskih zabolevanij. Vestnik RAMN. 1992; 7: 51-54. (In Russ).

38. Rabinowicz A.J., Correale J., Boutros R.B. et al. Neuronspecific enolase is increased after single seizures during inpatient video/EEG monitoring. Epilepsia. 1996; 37: 122-125.

39. Karjakina GM, Nadezhdina MV, Hinko MA. Nejrospecificheskaja enolaza kak indikator porazhenija mozgovoj tkani pri ishemicheskih insul’tah. Nevrologicheskij vestnik. 2007; 39(1): 41-44. (In Russ).

40. Cunningham, EJ, Bond, Mehta RZ. The European Carotid Surgery Trialists’ Collaborative Group. Long-term durability of carotid endarterectomy for symptomatic stenosis and risk factors for late postoperative stroke. Stroke. 2002; 33: 2658–2663.

41. Chernjavskij AM, Lomivorotov VN, Stoljarov MS, Derjagin MN, Strunin OV. Kislorodnoe obespechenie golovnogo mozga v uslovijah na jetapah operacii karotidnoj jendarterjektomii. Patologija krovoobrashhenija i kardiohirurgija. 2003; 2: 38-41. (In Russ).

42. Gavrilenko AV, Kuklin AV, Skrylev SI, Agafonov IN. Pokazanija dlja ispol’zovanija vnutriprosvetnogo vremennogo shunta pri operacijah na sonnyh arterijah. Angiologija i sosudistaja hirurgija. 2007; 13(4): 105-112. (In Russ).

43. Antunes M, Biala G. The novel object recognition memory: neurobiology, test procedure, and its modifications. Cogn. Process. 2012; 13(2): 93-110.

For citation

Batrashov V.A., Yudaev S.S., Zemlyanov A.V. Surgical correction of pathological tortuosities of internal carotid arteries: current state of the problem. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(3):61-67. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_61