doiSerbia

Acute reversible ischaemic neurological deficit induced by internal carotid artery kinking: Case report

Ilić Miodrag (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Tanasković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Ilijevski Nenad (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Radak Đorđe (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)

Introduction. Internal carotid artery (ICA) kinking is a pathological malformation with angulation of the vessel’s axis of 90° or less. It is known that kinking causes the reduction of flow within the vessel that may be exacerbated by progressive head rotation up to the point that causes complete cessation of flow. In this article, we report on the case of acute reversible ischaemic deficit induced by internal carotid artery kinking and immediate neurological recovery following surgical reconstruction. Case Outline. A 64-year-old woman was admitted to Vascular Surgery Clinic due to severe dizziness, fainting and walking instability, suddenly arising a few days prior to admission. Two years before, the left ICA reconstruction was done for kinking, after which there was no cerebral ischaemia symptoms. Symptoms have been present perpetually, enhanced when resting and with head movement. CT angiography (MSCT) showed haemodynamic significant right ICA kinking. The left ICA postoperative finding was regular. Computerized tomography (CT) of the endocranium was done and no novel lessions were verified than those seen two years earlier. Resection, shortening and reimplantation of the right ICA were performed. A few hours following surgical reconstruction, there was no cerebral ischaemia symptoms, neither when resting nor with head movement. On the third postoperative day, the patient was discharged for home treatment. Conclusion. Surgical repair for symptomatic ICA kinking contributes to cerebral ischaemia symptoms reduction, improves cerebral perfusion and significantly prevents carotid thrombosis and stroke. In this paper, we have seen that in case of acute cerebral ischaemia symptoms and ICA kinking, surgical ICA treatment appears to be justified.

Keywords: internal carotid artery kinking, cerebral ischaemia, reversible ischaemic neurological deficit (RIND)