Carotid Kinking as a Cause of Cerebral Insufficiency

TRANSVERSE ENLARGEMENT of vessels is well recognized' and is known to result in aneurysmal formation. Most often this condition coexists with arteriosclerotic degeneration of the aorta or the major arteries.2-4 Of equal importance and more frequently recognized is the clinical entity of elongation and tortuosity of the aorta and the major arteries, secondary to degenerative changes of the blood vessels.5' 6 In patients who have conspicuous elongation of the aorta or arteries, tortuosity is often demonstrable. In the carotid artery, elongation and tortuosity are fairly common.7' 8 Actually, for some time, the frequency of such findings prevented their recognition as significant factors in cerebral insufficiency. In 1925, Kelly9 postulated that increased tortuosity of the carotid artery was a result either of embryologic error or of arteriosclerotic change. With the increasing use of arteriography, many patients have been found to have twisted or kinked carotid arteries, and the relation of this finding to cerebral insufficiency has become apparent;' however, attempts at surgical correction were for so long unsuccessful that lesions of this type came to be considered untreatable by surgical means. Carotid insufficiency because of tortuosity of the artery has recently been diagnosed at John Sealy Hospital in several acutely ill patients with strokes. In most cases, surgical repositioning of the artery brought about a favorable outcome. Case reports of two of these patients are cited. The purpose of this paper is to describe the clinical course in the two patients with arterial insufficiency secondary to kinking of the arteries to the brain and to discuss the methods used in diagnosis and treatment.