Current Understanding of Dolichoarteriopathies of the Internal Carotid Artery: A Review

Abstract

Dolichoarteriopathies of the internal carotid artery (DICAs) are not uncommon, and although several studies have investigated DICAs, several questions regarding the etiology and best management course for DICAs remain unanswered. It is also difficult to correlate the occurrence of DICAs with the onset of clinical symptoms. Therefore, we surveyed the literature in PubMed and performed a review of DICAs to offer a comprehensive picture of our understanding of DICAs. We found that DICAs can be classified into three types, specifically tortuous, coiling and kinking, and are not associated with atherosclerotic risk factors. Cerebral hemodynamic changes are mainly associated with the degree of bending of DICAs. DICAs can result in symptoms of the brain and eyes due to insufficient blood supply and can co-occur with a pulsatile cervical mass, a pharyngeal bulge and pulsation. The diagnostic tools for the assessment of DICAs include Doppler ultrasonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA), and although DSA remains the gold standard, Doppler ultrasonography is a convenient method that provides useful data for the morphological evaluation of DICAs. CTA and MRA are efficient methods for detecting the morphology of the cervical segment of DICAs. Some DICAs should be treated surgically based on certain indications, and several methods, including correcting the bending or shortening of DICAs, have been developed for the treatment of DICAs. The appropriate treatment of DICAs results in good outcomes and is associated with low morbidity and mortality rates. However, despite the success of surgical reconstruction, an appropriate therapeutic treatment remains a subject of numerous debates due to the lack of multicentric, randomized, prospective studies.

Keywords: Dolichoarteriopathy; Internal Carotid Artery; Review; Treatment.

Figure 1

Types of DICAs. A: Tortuous, B: Coiling, C: Kinking. CCA: common carotid artery, ECA: external carotid artery, ICA: internal carotid artery

Figure 2

Grades of kinking. A: Grade I, B: Grade II, C: Grade III.

Figure 3

Surgical correction of the bending of DICAs. A: Preoperation, B: Postoperation.

Figure 4

End-to-end anastomosis of DICAs. A: Preoperation, B: ICA-to-bulb anastomosis to shorten the ICA, C: End-to-end anastomosis to shorten the ICA.

Figure 5

End-to-side reimplantation. A: Preoperation, B: End-to-side CCA, C: End-to-side ECA.

Figure 6

Carotid endarterectomy with a patch. A: Preoperation, B: “Common carotid artery imbrication” technique.

Figure 7

Eversion CEA with resection of the excess ICA. A: Intraoperation, B: Postoperation.

Figure 8

Bypass grafting. A: Preoperation, B: Postoperation.

Figure 9

Images of a typical case. A-B: MRI showed infarction of the right hemisphere, C: Perfusion MRI showed a reduction of cerebral blood flow in the right hemisphere, D-F: The CTA showed bilateral kinkings, and the right one was serious. G-H: The Doppler ultrasound showed that the proximal blood flow of the right ICA kinking was 48.7 cm/s, and the distal blood flow was 105.8 cm/s, I-J: The operation showed that the kinking was removed, and end-to-end anastomosis was performed to shorten the ICA. K-L: The intraoperative DSA showed that the ICA recovered its normal shape.

Figure 9

Images of a typical case. A-B: MRI showed infarction of the right hemisphere, C: Perfusion MRI showed a reduction of cerebral blood flow in the right hemisphere, D-F: The CTA showed bilateral kinkings, and the right one was serious. G-H: The Doppler ultrasound showed that the proximal blood flow of the right ICA kinking was 48.7 cm/s, and the distal blood flow was 105.8 cm/s, I-J: The operation showed that the kinking was removed, and end-to-end anastomosis was performed to shorten the ICA. K-L: The intraoperative DSA showed that the ICA recovered its normal shape.