Causes of tortuosity of the carotid artery. S-shaped tortuosity of the internal carotid artery. Pathological Tortuosity of the Internal Carotid Artery: Symptoms of Curvature, Treatment, What to Do

Development of ultrasound diagnostics vascular diseases brain changed the idea of the prevalence and significance of pathological tortuosity (PI) of the carotid arteries as a cause of cerebrovascular accidents. As a cause of cerebrovascular accident in adults, pathological tortuosity of the internal carotid arteries (ICA) is second only to atherosclerotic lesions in prevalence.

A feature of the diagnosis of pathological tortuosity of the ICA is the possibility of detection during a standard ultrasound examination.

Currently, there is no generally accepted terminology to indicate violation of the straightness of the ICA. In the domestic literature, the most widely used term is “pathological tortuosity of the carotid arteries,” proposed by E.V. Schmidt in 1975. This designation of violations of the straightness of the ICA has a deep clinical and pathophysiological basis, since it characterizes various variants of ICA deformation from the standpoint of their clinical significance. The use of this term implies not only the designation of the disturbed geometry of the ICA, but also the significance of the incorrect course of the ICA in the formation of cerebral hemodynamic disorders with a certain clinical picture.

There is no generally accepted classification of pathological tortuosity of the ICA. The most widely used classification is pathological forms BCA proposed by J. Weibel and W. Fields. The authors distinguish three types of ICA deformation, designating them as tortuosity, coiling, and kinking. Tortuosity means S- or C-shaped deformity ICA (Fig. 1, 2) without sharp angles and visible blood flow disturbances. The authors consider this type of ICA deformity to be congenital and hemodynamically insignificant.

Rice. 1. C-shaped tortuosity of the internal carotid artery (ICA) in color mode duplex scanning(CDS).

Rice. 2. C-shaped tortuosity of the ICA in B-mode (a) and CD (b).

Looping (“coiling”) is characterized by a congenital circular deformity with the formation of a loop (Fig. 3), which can lead to impaired cerebral circulation.

Rice. 3. Loop-shaped tortuosity of the left (a) and right (b) ICA in the CD mode.

Kinking is understood as acquired, hemodynamically significant angulation of the ICA with stenosis of its lumen (Fig. 4).

Rice. 4. Loop-shaped tortuosity of the ICA with kinking in the CDS mode (a) and schematically (b).

Color duplex scanning (CDS) allows not only to assess the shape of the tortuous carotid artery, but also to characterize the hemodynamic state in detail. In accordance with this, all types of violation of the straightness of the ICA can be divided into “hemodynamically significant” and “hemodynamically insignificant”.

The introduction of modern ultrasound diagnostic methods into clinical practice indicates a high prevalence of pathological tortuosity of the ICA. According to F. Koskas et al. , the tortuous course of the carotid arteries occurs in 10-43% of cases in patients with cerebrovascular accidents. It is important that the frequency of detection of pathological tortuosity of the ICA in adults ranked second after atherosclerosis of the carotid arteries. A study conducted by V.P. Kulikov et al. showed that among the patients in whom pathological tortuosity of the carotid arteries was identified based on the results of CDS, there were slightly more women (56.1%) than men (43.9%), pathological tortuosity of the right ICA was more often diagnosed (42.3%) Compared to the left (25.1%), 32.6% had bilateral tortuosity. Thus, it was shown that pathological tortuosity of the ICA is a common pathology not only in patients, but also in the population.

The etiology of pathological tortuosity of the ICA has not been definitively established. Today, there are two points of view on the causes of pathological tortuosity of the ICA - both congenital and acquired pathology.

Congenital genesis is supported by the detection of deformed carotid arteries in young patients in the absence of atherosclerotic process in the vessels, and frequent bilateral damage to the carotid arteries.

The acquired nature of the pathological deformation of the ICA may be evidenced by the high frequency of detection of this pathology with age and the dependence of the severity of the carotid artery bend on age and level blood pressure.

Pathological tortuosity In its clinical manifestations, the ICA resembles the symptoms of atherosclerotic stenosis of the ICA and manifests itself with signs of cerebrovascular accident. Most often, deformation of the carotid arteries is combined with arterial hypertension and atherosclerosis. In general, clinical manifestations of pathological tortuosity of the ICA are not very specific. Local signs of pathological tortuosity have some specificity, including pathological pulsation in the neck, signs of compression of the hypoglossal, accessory and vagus nerves.

However, most symptoms and syndromes are nonspecific. The most common pathological tortuosity of the ICA is motor impairment, blurred vision, headaches, speech impairment, dizziness, loss of consciousness, noise and ringing in the ears, pain in the neck, and epileptiform seizures.

Lack of specific clinical signs pathological tortuosity of the ICA significantly complicates the identification of this pathology based on the results of a clinical examination.

Detection of pathological tortuosity of the ICA in connection with its low-specific clinical manifestations is possible only with the help of specialized instrumental diagnostic methods. Given the limitations of radiocontrast angiography and magnetic resonance angiography, the main method for detecting ICA deformity is CD. This method combines the ability to visualize vessels and blood flow in them with the study of the nature and quantitative parameters of blood flow.

Ultrasound criteria for hemodynamic disturbances in pathological tortuosity of the ICA are recorded by Doppler methods locally - in the zone of vessel tortuosity. These violations can be recorded using different options and in .

Typical picture of pathological tortuosity of the ICA various shapes in the CDS mode is shown in Fig. 3-6. The CDS method makes it possible to characterize in detail the shape of tortuosity, its localization and identify disorganization of blood flow. The criteria for the local hemodynamic significance of pathological tortuosity of the ICA are: gradient of peak systolic blood flow velocity between the proximal and distal sections of the vessel in relation to the site of tortuosity with a decrease in velocity in the distal direction by 20% or more; an increase in peak velocity at the site of angulation compared to the proximal portion of the ICA by 30% or more; disorganization of blood flow in the tortuosity zone, manifested by an increase in spectral expansion and disruption of the blood flow pattern in the mode; the presence of asymmetry in the peak blood flow velocity in the distal section of the tortuous artery compared with the same section of the unchanged contralateral ICA. Thus, from the data presented above it follows that one of the links in the pathogenesis of cerebral circulatory disorders in pathological tortuosity of the ICA is a local disturbance of hemodynamics in the tortuosity zone with a decrease in blood flow in the distal direction.

Rice. 5. Loop-shaped tortuosity with kinking from the mouth and high-lying S-shaped tortuosity of the ICA in the CDS mode.

Rice. 6. S-shaped pathological tortuosity of the ICA in the CD mode (a, b).

A retrospective analysis of case histories of 36 patients at the clinic who were subsequently diagnosed with pathological tortuosity of the ICA according to CDS data showed that neurologists on an outpatient basis established a clinical diagnosis of chronic cerebrovascular accident in 18.9% of cases, acute cerebrovascular accident in 6.7% of cases. , cerebral angiodystonia - in 16.4%, cervical osteochondrosis - in 10.1%, consequences of traumatic brain injury, intracranial hypertension, cephalalgia, hypertension - in 18.2% of cases. Patients referred for examination without clinical diagnosis, in whom pathological tortuosity of the carotid arteries was discovered during CDS, amounted to 29.7%.

Moreover, to assess the informativeness of CD in diagnosing pathological tortuosity of the ICA, we analyzed the medical records of 9 patients who underwent angiography and surgical treatment. Concordance of the results regarding the presence of pathological tortuosity of the ICA was noted in 100% of cases. However, discrepancies were also found in the assessment of the shape and location of tortuosity. Obviously, the reason for the discrepancies is the lack of a generally accepted classification of pathological tortuosity of the ICA and clear assessment criteria for both the form and localization of tortuosity.

Currently, pathological tortuosity of the ICA can be the cause of transient and persistent cerebrovascular accidents. With modern ultrasound equipment, the diagnosis of pathological tortuosity of the ICA is not possible. technical complexity and the main method is primarily CDS.

Literature

Vascular diseases nervous system/ Ed. E.V. Schmidt. M.: Medicine, 1975. 663 p.
Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. I Etiology and radiographic anatomy // Neurology. Minneap, 1965. V. 15. P. 7-18.
Koskas F., Kieffer A., Kieffer E. et al. Loops and folds of the carotid and vertebral arteries: indication for surgery // J. Malad. Vascul. 19 Supl. A. 1994. P. 51-54
Kulikov V.P., Khoreyev N.G., Gerasimenko I.N. and others. Color duplex scanning of vessels in the diagnosis of pathological tortuosity of the carotid arteries // Echography. 2000. N 2. S. 147-154.

It is a pair: the left part begins in the region of the brachial trunk, the right - in the region of the aortic arch. In this case, both vessels end in the thoracic part. The internal carotid artery promotes blood supply and nutrition to all organs of the head, so any pathology can provoke serious consequences for the entire body.

Kinking of the internal carotid artery is a phenomenon of its pathological tortuosity in the form of an inflection.

Anatomical features

The carotid arteries are not absolutely symmetrical - the left one is always several centimeters larger than the right one. These vessels are responsible for the blood supply to the brain, eyes, etc. At the same time, for normal functioning the brain needs to receive blood at the rate of 3.7 grams per minute for every 100 grams of this organ.

In the area of cartilage thyroid gland this vessel forms several branches and is divided into the external carotid and internal carotid arteries.

Norm

IN in good condition it has no constrictions that prevent blood from flowing into the head. However, if the lumen in one of its parts is narrowed, a violation of the blood supply to the organs of the head develops. A common cause of ischemic stroke, hypertension or nervous disorders is a disruption of this physiological process due to tortuosity or kinks of the internal carotid artery.

Types of vascular pathologies

One of the most common causes of cerebral blood flow disorders is the tortuous structure of the carotid artery. More than 28% of patients who died from a stroke had this pathology. In almost every fourth case, a comprehensive examination reveals elongation or tortuosity of this vessel.

Experts distinguish the following types of tortuosity of the internal carotid artery:

Reasons for the development of kinking

In most cases, kinking of the internal carotid artery is a congenital pathology, but often development similar disease Other factors contribute, the list of which includes:

age-related vascular changes;
persistent high blood pressure;
smoking;
diabetes;
unhealthy diet with a lot of fats and carbohydrates;
overweight.

Also plays a huge role in the development of the disease hereditary factor. If relatives have been diagnosed with this pathology, it is necessary to undergo diagnostics. The development of kinking can be provoked by sedentary lifestyle life.

Symptoms of the pathological phenomenon

Most often, people with kinking of the internal carotid artery complain of the following symptoms:

frequent occurrence headaches that do not go away after taking painkillers;
periodically increasing noise and sound phenomena in the ears;
periodic fainting, which can last a couple of seconds;
fog or goosebumps before the eyes;
impaired coordination of movements;
in more difficult cases- speech disorders and weakness upper limbs.

Thus, the symptoms of kinking of the left internal carotid artery or the right are very similar to a number of other vascular diseases, for example, vascular atherosclerosis, which is common among older people. To determine the disease, it is necessary to carry out a number of necessary diagnostic procedures.

Diagnosis of kinking

To identify kinking - pathological tortuosity of the internal carotid artery, comprehensive diagnostic measures. To begin with, the specialist conducts a survey of the patient, identifying situations and identifying moments when his health worsened. Auscultation (listening with a phonendoscope) of the carotid arteries is mandatory to determine the presence or absence of pathological noise and measurement of blood pressure.

In addition, one of the instrumental diagnostic techniques should be used:

Treatment of the disease

The only one effective technique Kinking therapy is considered a surgical intervention. In this case, surgeons cut off the excess section of the artery, straightening the vessel. As a result of this operation, the blood supply to the head and brain is completely restored.

Since such surgical intervention, thanks to modern medical techniques, is the least traumatic, and its implementation rarely takes more than 20 minutes, in most cases it is carried out under local anesthesia. After the operation, the patient is sent to the hospital, and he is discharged on ambulatory treatment in the absence of complications, it is performed in one to two days.

The efficiency of the operation is very high. All pathological symptoms completely disappear in approximately 95% of patients. The probability of complications occurring is no more than 1%.

Drug therapy in this situation is ineffective, since it only alleviates the symptoms, but does not eliminate the problem itself - the pathological bending of the vessel.

Treatment in childhood

Therapy for carotid artery kinking childhood has some features. In general, this disease began to be detected in children relatively recently, which is due to the lack of the necessary diagnostic equipment in most medical institutions.

Most often, a very effective method of treating kinking in children is surgery. But, given the fact that the child is in constant development, sometimes it is possible to eliminate or cure such a pathology without surgical manipulation. In some cases, tortuosity goes away on its own as the child grows. This phenomenon is observed in almost 30% of cases. You can improve blood supply to the brain and prevent the development of ischemic disorders with the help of special exercises which the specialist shows. In case such exercises positive effect If they don’t give it, doctors resort to surgical intervention, especially in situations where the child feels very bad.

Preventive measures

To avoid the development of such a pathology, it is necessary:

stick to the basics healthy eating;
control body weight, exercise moderately;
give up bad habits;
exclude heavy lifting, as a result of which the pressure on the vessels increases, and the internal carotid artery begins to gradually deform.

The article briefly discussed carotid artery kinking. What it is and how to get rid of this pathology, you now know.

The question of choice remains relevant optimal method treatment of pathological deformation of the ICA. The priority is to search for minimally invasive correction methods with a minimal degree of trauma vascular wall.

More than 400,000 people suffer a stroke each year, and the incidence of cerebrovascular disease is trending upward.

Emerging hemodynamic disorders of cerebral circulation with pathological tortuosity of the ICA are not always limited to episodes of transient ischemic attacks (TIA) or the development of dyscirculatory encephalopathy, but can also lead to acute cerebrovascular accident of ischemic origin.

The incidence of pathological deformations of the carotid arteries in the group of patients examined by non-invasive diagnostic methods varies from 14 to 60%, second in prevalence only to atherosclerotic lesions of the carotid arteries.

Most convenient in clinical practice is a classification of pathological deformations of the internal carotid arteries, proposed by J. Weibel and W. Fields, which distinguishes three types of deformation (Fig. 1):

Rice. 1. Classification of pathological deformations of the internal carotid arteries according to J. Weibel and W.S. Fields:

a - S-shaped tortuosity of the carotid artery without sharp angles; b - C-shaped tortuosity of the carotid artery without sharp angles;

c - kinking - bending, angulation of one or several segments of the carotid arteries; d - coiling - tortuosity leading to the formation of a loop.

The pathogenesis of cerebrovascular insufficiency in pathological tortuosity of the ICA is associated with hemodynamic disturbances leading to thrombus formation. These processes are caused by restriction, unevenness, inversion of blood flow and the collision of antegrade and retrograde blood flows. Proof of this was the identification in 1980 of N.V. Vereshchagin of a special type of “stagnant blood clots” and the absence of atheromatous plaques at the site of their development.

In addition to the hemodynamic mechanism, disturbances due to cerebral embolism are possible. Turbulence of blood flow caused by narrowing of the lumen of the artery leads to the formation of microthrombi, platelet aggregates, which is the cause of arterio-arterial embolism of intracranial vessels.

In the bend itself, with pathological deformation of the ICA, the local blood pressure, minimal at the cut of the artery on the inner wall, progressively increases and reaches a maximum on the outer wall of the bend. The local speed of blood flow also changes in inverse proportion to the local pressure - minimum at the outer radius and maximum at the inner radius. In this case, due to the pressure gradient, stable secondary flows of transverse blood circulation arise, which are turbulent in nature. These changes lead to a decrease in perfusion pressure in the terminal branches of the pathologically altered artery, which, with insufficient collateral circulation, can lead to a number of ischemic changes.

Clinical manifestations The pathological tortuosity of the ICA is diverse, but at the same time there are no pathognomonic symptoms and syndromes. Most often they occur in the form of headaches, dizziness, noise and ringing in the ears, and impaired cognitive function. Pathological tortuosity of the ICA causes severe neurological disorders such as TIA and ischemic stroke. The number of patients with previous or remaining neurological deficit varies from 3 to 36%.

The polymorphism of developing neurological disorders with pathological deformation of the ICA has not been fully studied. Symptoms of cerebral ischemia can be in the hemisphere on the side of the ICA tortuosity in 26% of patients, non-hemispheric symptoms occur in 41.7% of cases, their combination occurs in 27.5% of patients.

In vascular surgery, in order to determine the severity of ischemic brain damage in this pathology, the classification proposed by A.V. is most often used. Pokrovsky. It has four degrees:

I - asymptomatic course of the disease;

II - transient disturbances cerebral circulation;

III— chronic course cerebrovascular insufficiency;

IV - history of stroke.

A.V. Gavrilenko et al. note that even with an asymptomatic course of the disease, it is possible to diagnose such signs of visual impairment as ocular ischemic syndrome, decreased light sensitivity, macular degeneration (to identify these disorders, it is necessary special methods eye examinations).

The most common method for diagnosing pathological deformation of the ICA has become ultrasound duplex scanning in color and power Doppler mapping modes.

Criteria for the significance of changes in blood flow during ICA deformation:

Peak systolic blood flow velocity;

End diastolic velocity;

Index of peripheral vascular resistance in the proximal and distal areas in relation to tortuosity.

Ultrasound of the vessels of the neck and head

(below - pathological tortuosity of the internal carotid artery)

According to A.V. Pokrovsky, blood flow turbulence and the ratio of linear blood flow velocity (LBV) proximal to the tortuosity to LSV at a deformation level equal to 2.5 or more, with a LSV value at a deformation height of at least 150 cm/s, are indications for surgical treatment.

BY. Kazanchyan and E.A. Rollers are considered an indication for surgical treatment by increasing the peak systolic frequency to 8 kHz or more and the maximum systolic blood flow velocity to 200 cm/s or more, regardless of the clinical manifestation of the disease.

To study hemodynamics in intracranial vessels, transcranial Dopplerography is performed, thanks to which it is possible to evaluate the linear speed, direction and spectral component of blood flow in the intracranial branches of the ICA, posterior cerebral arteries, and determine the state of collateral circulation in the anterior and posterior communicating arteries.

Despite the fact that signs of a stroke are recorded mainly in symptomatic patients and are more common in male patients, patients diabetes mellitus, the probability of detecting “silent” lesions using contrast enhancement on CT is also high.

Currently, there are many methods for correcting ICA tortuosity by straightening or resection of the affected segment. In 1951, M. Riser et al. were the first to identify a connection between carotid kinking and cerebrovascular insufficiency. The surgical technique consisted of fixing the tortuous ICA to the sheath of the sternocleidomastoid muscle, after which the patient’s “dizziness crises” were stopped. Because of large quantity relapses in long-term period selection of options radical operations in order to correct the impaired blood flow continues. In 1956, I. Hsu and A. Kisten first performed reconstruction of the ICA with its pathological tortuosity, but thrombosis of the anastomosis led to death.

In 1959, J. Quattlebaum performed the first successful operation on a 59-year-old woman with kinking of the left ICA and developed right-sided hemiparesis. Using the method of resection of the common carotid artery, the direct course of the ICA was restored, after which neurological symptoms were stopped, and the patient remained asymptomatic for more than 10 years. But this technique did not take into account the condition of the artery wall in the area of deformation, and sometimes there was a need for resection of the affected segment.

In 1960, E. Hurwitt performed resection of the altered segment of the ICA with end-to-end reanastomosis of the artery as an alternative to eliminating the deformity by resection of the common carotid artery (CCA) with reanastomosis. In 1961, W. Lorimer proposed resection and reduction of the ICA with implantation into the anterior or lateral wall of the common carotid artery below its bifurcation - this operation, unlike the J. Quattlebaum method, did not require ligation of the external carotid artery.

In 1989 P.A. Pauliukas and E.M. Barkauskas suggested using the technique of mobilization, resection of the ICA, reduction of excess length, resection of the proximal segment of the ICA and implantation into the “old” mouth with the formation of a wide anastomosis. The advantage of the technique was the simultaneous elimination of deformation and stenosis due to atherosclerotic lesions.

Scheme of the operation for resection of pathological deformation of the internal carotid artery with redressing and reimplantation into the old ostium: a - stage of isolation of the carotid arteries; b — resection of pathological tortuosity; c — the internal carotid artery after resection is implanted into the old ostium; G - schematic illustration operations

Commonly accepted techniques surgical correction pathological deformities internal carotid arteries

Resection of an area of pathological tortuosity with redressing and lowering of the ICA ostium- the most common operation. After isolating the carotid arteries, the ICA is divided at the ostium. The proximal incision is extended to the bifurcation of the carotid artery. The internal SA is opened along the inner wall to the level necessary to straighten the bend. The obliquely cut ICA is then pulled downwards to straighten the bend, and if necessary, the excess segment of the ICA is resected. The internal SA is rotated along the axis clockwise or counterclockwise depending on the direction of the deformation. The anastomosis between the ICA and the CCA is performed with a continuous end-to-end suture using a monofilament suture material 6-0.

Resection of an area of pathological tortuosity of the ICA with the imposition of an end-to-end anastomosis between the edge of the ICA and the mouth of the ICA. This technique also involves excision of the area of tortuosity of the ICA and restoration of the straight course of the vessel. In order to prevent possible stenosis anastomosis when suturing small-diameter vessels, immediately after the deformation area, the artery is crossed at an angle of 45°. Using scissors at the same angle, the ICA is crossed in the initial section, until it becomes tortuosity. After this, the ends of the arteries are sutured together with a continuous wrapping vascular suture in an end-to-end manner.

ICA prosthetics. Indications for this operation are hypoplasia of the carotid artery, thinning of the ICA wall due to degenerative-dystrophic changes in the artery, the presence of an aneurysmal change (microaneurysm) of the ICA, the location of tortuosity in the distal section, as well as violation of the integrity of the arterial wall in the area of deformation when trying to redress it. After resection of the ICA, an oblique distal anastomosis is first performed using a continuous enveloping suture (6-0 Prolene thread) with a linear prosthesis with a diameter of 6 mm or an end-to-end autovein. The prosthesis is anastomosed with the CCA at the “old” mouth of the ICA, also with a continuous wrapping suture (5-0 Prolene thread).

Scheme of the operation for resection of pathological tortuosity of the ICA with prosthetics

If the pathological tortuosity of the ICA has an accompanying atherosclerotic lesion, the selection method is eversion endarterectomy with resection of the area of pathological tortuosity of the ICA. The mouth of the ICA is cut off from the CCA, in which a rather large “window” is formed. The internal CA is crossed transversely and incised longitudinally along the medial wall by an amount equal to the length of the “window” in the CA. Eversion endarterectomy of the distal part of the ICA is performed (the distal end of the plaque must be visualized). The anastomosis is performed with a continuous enveloping suture using 6-0 or 5-0 polypropylene suture.

Immediately after surgical treatment of pathological tortuosity of the ICA, relief of neurological symptoms can be achieved in 75-100% of cases. Ischemic stroke and death occur in no more than 2% of operated patients, which corresponds to world data on the results of surgical treatment of patients with asymptomatic stenoses. When analyzing long-term results (average follow-up period up to 5 years), the incidence of stroke and mortality from it do not exceed 3.8%.

The question remains of the occurrence of peripheral neuropathy as a result of trauma to the cranial nerves during the formation surgical access to the deformed carotid artery, especially when it is localized in the middle and distal parts of the ICA. According to various authors, the frequency of neuropathy varies from 0.3 to 9.3%, in a third of cases the disease is permanent. So, according to A.A. Fokina et al., who have experience in performing 1362 reconstructions of the carotid arteries, cases of trauma facial nerve are 4.2%, injuries of the vagus nerve - 3.4%, hypoglossal nerve - 2%, accessory nerve - 0.1%.

In order to reduce the likelihood of injury to the fibers of the pharyngeal plexus and cranial nerves when isolating the middle and distal parts of the ICA, N.G. Khorev et al. "tunnel access" was developed. It looks like a tunnel, the side walls of which are the branches of the retractor, at the top there is the digastric (sometimes the posterior belly is crossed) and stylohyoid muscles, the glossopharyngeal nerve and branches of the facial nerve, at the bottom there is a deformed carotid artery, under which the vagus nerve and sympathetic ganglion are located.

With the development of minimally invasive methods of diagnosis and treatment in 1979, K. Mathias published the first report of successful endovascular intervention for lesions of the branches of the aortic arch. A method of dilatation of the carotid arteries was developed, which was used in 30 experimental dogs with artificially created stenoses of the CCA and ICA (more than 50% of the lumen). In 3 (9%) cases, it was possible to completely eliminate the stenosis, and in 23 (76%) cases, the degree of narrowing was significantly reduced. No disturbances in cerebral hemodynamics were observed after endovascular intervention. Considering the experimental results, in 1981 K. Mathias et al. For the first time in world practice, we performed successful operations on endovascular dilatation of atherosclerotic stenoses and occlusion of the subclavian and axillary arteries in 5 patients. In all cases, after endovascular treatment, a good angiographic and clinical result was observed.

In 2007, T.R. Lazaryan et al. reported stenting of a pathologically tortuous ICA in 15 unfixed cadavers for the purpose of endovascular correction under control hydrodynamic indicators. The intervention was performed on 6 vessels with a 90° bend, 5 with an S-shaped tortuosity, and 4 with a loop-shaped tortuosity. It was revealed that endovascular correction leads to the elimination of pathological tortuosity of the ICA and a significant decrease in the pressure gradient and an increase in fluid consumption. In addition, stenting of the ICA is not accompanied by trauma to the vascular wall, including the intima of the artery. However, there have been no reports of ICA stenting to correct its pathological tortuosity in clinical practice.

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Non-straightness of the vertebral arteries is a disease resulting from such pathologies cervical region spine, such as curvature, osteochondrosis, scoliosis and so on. Physiologically, the vertebral arteries pass in the protected area of the cervical spine. As a result of its destruction, they shift or narrow, reducing blood permeability and further pathologies of the brain.

The vertebral arteries are the main suppliers of blood to the brain. Statistics show that more than 50 percent of strokes occur due to pathologies associated with the vertebral arteries. For this reason, they must be treated with full responsibility and, if symptoms of illness occur, immediately seek medical help.

Timely identification of the problem can significantly speed up the diagnostic and treatment processes. For this reason, it is worth remembering a number of symptoms, if they occur, you should contact a neurologist and orthopedist.

Frequent headaches in the back of the head;
Neck pain;
The appearance of a pre-fainting state with sudden movements;
Increased intracranial pressure;
Constant or intermittent weakness in the arms, legs, or fingers;
Spontaneous attacks of nausea;
Loss of coordination and problems with the vestibular system;
Systematic visual impairment.

These symptoms do not directly indicate that the problem lies specifically in the vertebral arteries, they just indicate. However, it is often associated with the vertebral arteries.

The non-linearity of the course means that instead of the direct and shortest path to the brain, the artery is located along a tortuous path. To correct the pathology, it is necessary to act not on the arteries, but on the primary problem - the cervical spine. Let's look at the causes of the disease in more detail.

Causes

Modern medicine divides the causes of non-straightness of the arteries in the cervical spine into 2 categories - vertebrogenic and non-vertebrogenic.

Vertebrogenic causes are associated with pathologies of the development of the spine or changes in its structure, both in children and adults. In children, this pathology can occur for the following reasons:

Cervical spine injuries. They can occur at any age, including the birth process, which is quite dangerous for a child;
Pathological muscle spasms. Often droops as a result of hypothermia. Changes in the tone and location of the muscle affect the position of the artery, as a result of which the capacity of the latter decreases.

Vertebrogenic causes of pathology in adults arise for other reasons, among which the main ones are the following diseases:

Swellings of the cervical spine or occipital part of the brain;
Osteochondrosis;
Ankylosing spondylitis;
Trauma, as in children, can also affect the condition and location of the artery.

Interesting read:

Among non-vertebral causes, it is worth noting the following groups of diseases:

Inflammation, atherosclerosis, embolism and other diseases that cause loss of artery elasticity and tone;
Diseases affecting the shape of arteries, kinks, etc.;
Pathologies associated with changes in the shape of arteries as a result of compression. Among the reasons are anomalous location ribs, tissue scarring as a result surgical intervention and so on.

The danger of the non-straight course of both arteries is that it increases the likelihood of ischemic attacks in various parts of the brain. If you ignore the symptoms of the disease, there is a risk of cerebral stroke. Rehabilitation after a stroke is not always possible, and complete correction of its consequences is impossible.

Diagnostics

At the first appearance of symptoms, you should contact your physician for an initial examination. After this, he gives a referral to a neurologist, who is engaged in further diagnosis and treatment of the disease. Most effective diagnostic methods when this problem occurs are:

Ultrasound Dopplerography. Using this method, both vertebral arteries are examined for the speed of the blood flow wave in order to determine the effectiveness of cerebral circulation and its reserve;
MRI of the vessels of the cervical spine and brain. MRI allows you to determine the presence of aneurysms and inflammation in the arteries, including places where blood flow is disrupted;
An X-ray of the cervical spine is also necessary, since with this method it is possible to see the condition bone tissue, the position of the vertebrae and processes, on the basis of which conclusions are drawn about the possible;
Usage contrast agent, which is introduced into the subclavian artery by injection. This method called vascular angiography. It allows you to determine the presence of kinks or changes in the position of the arteries.

The presence of severe deformation, abnormal weaving or curvature of the carotid artery, which is usually a congenital abnormality, can lead to serious consequences if not treated promptly. Such a defect is formed due to the predominance of elastic fibers over collagen, which causes severe tissue wear.
The disease can also be acquired and develop due to atherosclerosis of the carotid artery due to prolonged hypertension.
Timely diagnostics and treatment can reduce the risk dangerous complications diseases and improve the patient's quality of life.

Serious consequences

Pathological tortuosity of the carotid artery leads to transient ischemic attacks, which may cause temporary paralysis of the upper limbs and speech impairment. Such a deviation causes noise in the head, migraine attacks, impaired coordination of movements, and short-term fainting.
Without proper treatment, the disease leads to chronic failure blood circulation in the brain, which manifests itself as constant oxygen starvation of tissues. As a result, neurons are constantly under tension, which is why the organ cannot function normally.

In the case of a pronounced two-knee S-shaped bend (see Fig.), under the influence of surges in blood pressure or when turning the head to the sides, these “knees” fold for a moment and blood does not flow into the brain, a violation of cerebral circulation occurs, leading to a stroke !

Prevention and treatment

Diagnostics in this case is aimed at assessing the nature of blood flow in the tortuosity zone and obtaining hemodynamic parameters. Studies are carried out using ultrasound duplex scanning of the carotid arteries (USDS), spiral computed tomography, X-ray contrast angiography.
Based on the information obtained as a result of this diagnosis, a future treatment strategy is formed.

At pronounced change blood flow (according to ultrasonography of the carotid arteries) and the presence of the symptoms indicated above, pathological tortuosity can only be eliminated through surgery, which consists of shortening the affected or deformed area (resection), which leads to the restoration of normal blood flow.

Surgery.
Resection of the S-shaped bend of the carotid artery.
Field photography

Fig.1. Computed tomogram of the tortuosity of the internal carotid artery, the arrow indicates an S-shaped bend, in the form of the so-called “two knees”.

Fig.2. Operative photograph of this S-curve.

Fig.3. The curved internal carotid artery is cut off from the common carotid artery, straightened, and the excess artery is cut off (resected) and sutured back into the common carotid artery.

Fig.4. The final appearance of the artery after resection: the artery lies correctly, evenly and without bends.

In case of atherosclerosis (stenosis) of the carotid artery, the atherosclerotic plaque is removed according to the same principle as in the operation of carotid endarterectomy.

To eliminate the risk of disease, you should maintain normal level cholesterol, control body weight, promptly treat arterial hypertension and manage active image life.