The structure of the internal carotid artery wall in pathological tortuosity

Paltseva, E. M.; Oskolkova, S A; Polyakova, V. O.; Krylova, Yu.S.; Иванова, А Г; Abramyan, A. V.; Гавриленко, А. В.

doi:10.17116/patol20157753-8

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…Type 1 is associated with the A80807T polymorphism of the transcription factor Sp4, as well as with matrix metalloproteinase-2 (MMP-2) (1,12,13). It can also be associated with fibromuscular dysplasia and with Loeys-Dietz syndrome type IB (14). Type 2 is associated with all atherosclerotic risk factors, including hypertension, hypercholesterolemia, diabetes mellitus and smoking (1).…”

Section: Discussionmentioning

confidence: 99%

Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction

Amidzic

Tiro

2020

Med Arch

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Introduction: Dolichoarteriopathies of the internal carotid artery (DICAs) is divided into three forms: tortuous, coiling and kinking. In case of kinking, internal carotid artery forms a sharp angle of <90 degrees, while in the background there is metaplasia of a tunica media with unknown etiology. The association with stroke is still questionable, but it is believed that it can be associated with cerebral ischemia and with clinical symptomatology that accompanies cerebral ischemia. Aim: Aim of article was to present diagnostic and therapeutic modality of patient with verified internal carotid artery kinking. Case report: The 55-year-old male patient was admitted to the Department of Neurology, General Hospital «Prim.dr. Abdulah Nakas», due to dizziness and instability while walking, forgetfulness, memory loss and low mood. He has previously been reported to be hypertensive and with diagnosis of diabetes mellitus and dyslipidemia. Doppler sonography also suspects on distal subocclusion of the internal carotid artery (low flow rates were observed). Diagnostic transcranial Doppler (TCD) of vertebrobasilar artery showed decreased blood flow velocities in both vertebral and basilar artery and indicated atherosclerotic altered blood vessels of the brain. CTA findings indicate bilateral kinking of internal carotid artery with right duplex Kinking. SPECT with 15 mCi 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO) verified global cortex hypoperfusion, indicating chronic vascular failure. The patient was treated with acetylsalic acid, clopidogrel, atorvastatin, donepezil, memantine, escitalopram, bromazepam, along with antihypertensive and antidiabetic therapy (per os). Conclusion: A severe degree of kinking can cause neurological symptomatology, especially if it is bilateral. Symptoms of cerebrovascular disease are more pronounced when autoregulation of cerebral hemodynamics is impaired. Bilateral severe degree of kinking possibly can cause cognitive impairment. Diagnosis, analysis of the existence of possible risk factors for the onset, and the existence of genetic predisposition are a prerequisite for better understanding of the disease and optimal treatment.

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Section: Discussionmentioning

confidence: 99%

Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction

Amidzic

Tiro

2020

Med Arch

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“…Fibromuscular dysplasia (FMD) might genetically predispose patients to DICAs. For instance, Paltseva et al (2015) found that ICA walls with pathological tortuosity are observed in FMD patients and present with impaired vascular elastic properties due to the destruction of elastic fibers and a decreased abundance of smooth muscle cells, which result in the enhancement of MMP-9 activity and the induction of tissue matrix degradation 55 . This study demonstrated that the pathological changes associated with FMD could result in DICAs.…”

Section: Pathogenesismentioning

confidence: 99%

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

et al. 2017

Int. J. Med. Sci.

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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.

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“…Confocal microscopy revealed low elastin and high matrix metalloproteinase-9 staining levels in the tortuosity group compared with the control group. 37 Another study of 10 ICA specimens from patients who underwent carotid reconstruction due to cCA DE reported the reduction of elastic fibers and smooth muscle cells as well as increased collagen. 38 Together, these results suggest that carotid tortuosity is related to an abnormal tissue matrix remodeling, which may involve an imbalance in metalloproteinase activity, smooth muscle cell maintenance, and elastic/collagen metabolism.…”

Section: Cervical Ca De Epidemiologymentioning

confidence: 99%

Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk

Khasiyev

Gutierrez

2020

Journal of Neuroimaging

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Cervical carotid artery (cCA) dolichoectasia (DE) is characterized by elongation, tortuosity, and/or dilatation. The prevalence of cCA DE has been reported 13-31% in population-based and 14-58% in hospital-based studies. The exact mechanisms of this aberrant arterial remodeling are unknown. Although atherosclerosis has often been implicated, the evidence has conflicting results that would support atherosclerosis as the underlying pathology. Actually, other nonatherosclerotic mechanisms related to connective tissue remodeling may play a role. Such mechanism is supported by epidemiological evidence that cCA DE is associated with carotid dissections. Similarly, cCA DE has been associated with vascular risk factors, but inconsistently. Fewer studies have evaluated the risk of vascular events in people with cCA DE. Cross-sectionally, cCA DE is associated with cerebrovascular disease, including white matter hyperintensities, lacunar stroke, and stroke overall. The often-conflicting results may in part be due to the heterogeneity of the population studies and variable definitions used. Preferential use of objective measure of cCA DE, such as carotid length, is advisable, and may help comparing result among different studies. Prospectively, people with cCA DE have a higher risk of vascular events, although it is uncertain if the risk of stroke is also higher in this population. In the absence of alternative stroke etiologies, stroke patients with cCA DE should be considered to have had a cryptogenic stroke and treated with daily antiplatelet therapy. Further population-based studies are needed to clarify whether specific therapies may be implement to reduce the risk of events among people with cCA DE.

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The structure of the internal carotid artery wall in pathological tortuosity

Abstract: One of the causes of PT is impairment in vascular elastic properties due to the destruction of elastic fibers and to their fragmentation, as well as to the decreased count of smooth muscle cells, which in turn causes enhanced MMP-9 activity and tissue matrix degradation.

Cited by 9 publications

References 6 publications

Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction

Kinking of Bilateral Internal Carotid Arteries as Cause of Cognitive Dysfunction

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

Cervical Carotid Artery Dolichoectasia as a Marker of Increased Vascular Risk

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