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

Abstract

Extracranial internal carotid artery (EICA) kinking and coiling are the most frequently reported carotid anomalies in the literature. Embryogenic and acquired causes for such anomalies have been postulated but the prevalence of kinking and coiling has not been well characterized across age categories. The aim of this study is to evaluate the prevalence of EICA coiling and kinking among different age groups to better understand its potential causes and changes during the course of life. A total of 2856 subjects aged 0 to 96 years were studied by echo-color Doppler (ECD). Morphology and anatomical anomalies of the EICA were assessed. Patients with anatomical anomalies were stratified by age groups and the prevalence of EICA abnormalities was calculated. The maximal velocity recorded at the level of the kinking was compared with that measured in the common carotid artery and the peak systolic velocity kinking ratio (PSVKR) was calculated. A total of 284 subjects (9.94% of the sample) were found to have kinking or coiling of the EICA. The prevalence was significantly higher at the extremes of age (≤ 20 and > 60 years old, p < 0.001) supporting the hypothesis of a reduction with growth and a new increase in the elderly. PSVKR was higher in subjects with more severity kinking. This study showed a higher prevalence of EICA coiling and kinking in the very young and in the elderly. This bimodal prevalence distribution supports the hypothesis of a congenital anomaly that resolves with somatic growth, while advanced age with its many anatomical changes leads to its reappearance or worsening. Studies with longitudinal follow-up and paired observation are required to support this hypothesis.

Age and duration of hypertension are associated with carotid artery tortuosity

“…We found that age and the duration of hypertension are independent risk factors for carotid artery tortuosity, while the use of antihypertensive drugs is a protective factor against carotid artery (3,20,24,25). With age, the elastic layer of blood vessels degenerates and breaks, and their integrity is destroyed.…”

“…In previous studies, the incidence rate of carotid artery tortuosity ranged from 4 to 87% ( 3 , 12 , 20 ). The incidence rate in this study was 63.6%, and such a large difference in the incidence rates across different studies may be due to the following reasons.…”

“…In addition to age, the duration of hypertension and antihypertensive drugs is related to blood pressure. Based on current research, although the acquired risk factors related to carotid artery tortuosity vary greatly among studies, age and hypertension are currently accepted by the majority of studies ( 3 , 20 , 24 , 25 ). With age, the elastic layer of blood vessels degenerates and breaks, and their integrity is destroyed.…”

Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results

“…5 In another study by Di Pino et al, the prevalence of carotid artery anomalies among adults and children did not exceed 9.9%. 6 It is known that DICA can be asymptomatic, but most often presents with hemispheric symptoms. Since this pathology is not well understood, there is no consensus among clinicians about the effectiveness of a particular type of Keywords ► bilateral ► cerebrovascular insufficiency ► dolichoarteriopathy ► internal carotid artery ► stroke ► surgery ► results…”

“…5 In another study by Di Pino et al, the prevalence of carotid artery anomalies among adults and children did not exceed 9.9%. 6…”