ORIGINAL PAPER
Clinical presentation and impact of internal carotid artery kinking in children
1
Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
2
Department of Pediatric Radiology, Poznan University of Medical Sciences, Poznan, Poland
Submission date: 2024-05-03
Final revision date: 2024-09-11
Acceptance date: 2024-09-15
Publication date: 2024-12-30
Corresponding author
Justyna Frąszczak
Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznań, Poland
Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznań, Poland
Pediatr Pol 2024;99(4):297-306
KEYWORDS
TOPICS
ABSTRACT
Introduction::
The internal carotid artery (ICA) is the principal source of blood supply to the brain, eye, and internal ear. A wide spectrum of clinical symptoms associated with dolichoarteropathy of that vessel has been described, with kinking being the most frequently reported and clinically relevant type of carotid abnormalities of the geometrical course of the vessel. The aim of the study was to analyze the clinical picture of ICA kinking in children.
Material and methods::
We retrospectively analyzed all pediatric patients hospitalized in our department with various indications from January 2021 to December 2023, by consulting all of the clinical records in search for those whose imaging tests revealed ICA kinking. Nineteen children with a confirmed diagnosis of ICA kinking were identified. Among all patients with detected ICA kinking, 13 (68.4%) at the time of admission presented with signs and symptoms that could be attributed to insufficient cerebrovascular circulation due to an anatomical abnormality of the ICA. The remaining 6 (31.6%) children were admitted for various clinical reasons and did not present symptoms that could have been linked with abnormal cerebral perfusion.
Results::
Thorough medical history, clinical presentation, and associated features of patients are reported, and a discussion in light of previously published papers on the subject is presented.
Conclusions::
We emphasize the importance of anamnesis and clinical awareness in any case of a pediatric patient with transient non-specific neurological manifestations that could suggest anomalies of ICA. An appropriate diagnostic approach can help to reduce possible risk, minimalize costs and guide personalized management of these patients.
The internal carotid artery (ICA) is the principal source of blood supply to the brain, eye, and internal ear. A wide spectrum of clinical symptoms associated with dolichoarteropathy of that vessel has been described, with kinking being the most frequently reported and clinically relevant type of carotid abnormalities of the geometrical course of the vessel. The aim of the study was to analyze the clinical picture of ICA kinking in children.
Material and methods::
We retrospectively analyzed all pediatric patients hospitalized in our department with various indications from January 2021 to December 2023, by consulting all of the clinical records in search for those whose imaging tests revealed ICA kinking. Nineteen children with a confirmed diagnosis of ICA kinking were identified. Among all patients with detected ICA kinking, 13 (68.4%) at the time of admission presented with signs and symptoms that could be attributed to insufficient cerebrovascular circulation due to an anatomical abnormality of the ICA. The remaining 6 (31.6%) children were admitted for various clinical reasons and did not present symptoms that could have been linked with abnormal cerebral perfusion.
Results::
Thorough medical history, clinical presentation, and associated features of patients are reported, and a discussion in light of previously published papers on the subject is presented.
Conclusions::
We emphasize the importance of anamnesis and clinical awareness in any case of a pediatric patient with transient non-specific neurological manifestations that could suggest anomalies of ICA. An appropriate diagnostic approach can help to reduce possible risk, minimalize costs and guide personalized management of these patients.
REFERENCES (29)
1.
Coulson W. Peculiar disposition of the large vessels, producing a tremor at the root of the neck. Trans Path Soc Lond 1852; 3: 302.
2.
Weibel J, Fields WS. Tortuosity, coiling, and kinking of the internal carotid artery. I. Etiology and radiographic anatomy. Neurology 1965; 15: 7-18.
3.
Metz H, Bannister R, Murray-Leslie R, et al. Kinking of the internal carotid artery. Lancet 1961; 277: 424-426.
4.
Yu J, Qu L, Xu B, et al. Current understanding of dolichoarteriopathies of the internal carotid artery: a review. Int J Med Sci 2017; 14: 772-784.
5.
Schechter DC. Dolicho carotid syndrome: cerebral ischemia related to cervical carotid artery redundancy with kinking: part I. N Y State J Med 1979; 9: 1391-1397.
6.
Becker C, Ridder GJ, Pfeiffer J. The clinical impact of aberrant internal carotid arteries in children. Int J Pediatr Otorhinolaryngol 2014; 78: 1123-1127.
7.
Brandt T, Morcher M, Hausser I. Association of cervical artery dissection with connective tissue abnormalities in skin and arteries. Front Neurol Neurosci 2005; 20: 16-29.
8.
Beneš V, Mohapl M. Alternative surgery for the kinked internal carotid artery. Acta Neurochir 2001; 143: 1267-1272.
9.
Beigelman R, Izaguirre AM, Robles M, et al. Are kinking and coiling of carotid artery congenital or acquired. Angiology 2010; 61: 107-112.
10.
Di Pino L, Franchina A, Costa S, et al. Prevalence and morphological changes of carotid kinking and coiling in growth: an echo-color Doppler study of 2856 subjects between aged 0 to 96 years. Int J Cardiovasc Imaging 2021; 37: 479-484.
11.
Sacco S, Totaro R, Baldassarre M, et al. Morphological variations of the internal carotid artery: prevalence, characteristics and association with cerebrovascular disease. Int J Angiol 2007; 16: 59-61.
12.
Sarkari N, Holmes J, Bickerstaff E. Neurological manifestations associated with internal carotid loops and kinks in children. Neurol Neurosurg Psychiatry 1970; 33: 194-200.
13.
Stanton P Jr, McClusky D Jr, Lamis P. Hemodynamic assessment and surgical correction of kinking of the internal carotid artery. Surgery 1978; 84: 793-802.
14.
Fields W. Selection of patients with ischemic cerebrovascular disease for arterial surgery. World J Surg 1979; 3: 147-154.
15.
Aleksic M, Schutz G, Gerth S, et al. Surgical approach to kinking and coiling of the internal carotid artery. J Cardiovasc Surg 2004; 45: 43-48.
16.
Cartwright M, Hickling W, Roach E. Ischemic stroke in an adolescent with arterial tortuosity syndrome. Neurology 2006; 67: 360-361.
17.
Grego F, Lepidi S, Cognolato D, et al. Rationale of the surgical treatment of carotid kinking. J Cardiovasc Surg 2003; 44: 79-85.
18.
Foiadelli T, Ippolito R, Corbetta R, et al. Clinical variability in children with dolichoarteriopathies of the internal carotid artery. Childs Nerv Syst 2020; 36: 621-628.
19.
Ballotta E, Thiene G, Baracchini C, et al. 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: 838-846.
20.
Smirnova I. On the advisability of surgical treatment of children with kinking of the internal carotid artery. Angiol Sosud Khir 2007; 13: 101-107.
21.
Voevoda MI, Kulikov IV, Maksimov VN, et al. Association of Sp4 gene polymorphismwith pathological tortuosity of internal carotid arteries. Kardiologiia 2009; 49: 46-49.
22.
Toyota A, Csiba L, Kollar J, et al. Morphological differences in carotid angiograms and their relation to age. Orv Hetil 1995; 136: 1551-1554.
23.
Macchi C, Gulisano M, Giannelli F, et al. Kinking of the human internal carotid artery: a statistical study in 100 healthy subjects by echocolor Doppler. J Cardiovasc Surg 1997; 38: 629-637.
24.
Pellegrino L, Prencipe G, Vairo F. Dolicho-arteriopathies (Kinking, coiling, tortuoosity) of the carotid arteries: study by color Doppler ultrasonography. Minerva Cardioangiol 1998; 46: 69-76.
25.
Chuang Y, Liu C, Pan P, et al. Posterior communicating artery hypoplasia as a risk factor for acute ischemic stroke in the absence of carotid artery occlusion. J Clin Neurosci 2008; 15: 1376-1381.
26.
Zhou W, Lu M, Li J, et al. Functional posterior communicating artery of patients with posterior circulation ischemia using phase contrast magnetic resonance angiography. Exp Ther Med 2019; 17: 337-343.
27.
Wardlaw J, Dennis M, Warlow C, et al. Imaging appearance of the symptomatic perforating artery in patients with lacunar infarction: occlusion or other vascular pathology? Ann Neurol 2001; 50: 208-215.
28.
Chuang Y, Huang Y, Hu H, et al. Toward a further elucidation: role of vertebral artery hypoplasia in acute ischemic stroke. Eur Neurol 2006; 55: 193-197.
29.
Bhanu S, Pentyala S, Sankar D. Incidence of hypoplastic posterior communicating artery and fetal posterior cerebral artery in Andhra population of India: a retrospective 3-Tesla magnetic resonance angiographic study. Anat Cell Biol 2020; 53: 272-278.
Share
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
