Association between carotid artery tortuosity and carotid dissection

A case-control study

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. METHODS: Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. RESULTS: A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46% of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53% (N.=44) and 34% (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22% (N.=18) of dissection patients and 8% (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23% (N.=38) of dissection patients and 9% (N.=15) of controls (P=0.0009) in the per-vessel analysis. CONCLUSIONS: Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalJournal of Neurosurgical Sciences
Volume62
Issue number4
DOIs
StatePublished - Aug 1 2018

Fingerprint

Carotid Arteries
Case-Control Studies
Dissection
Internal Carotid Artery
Anatomy
Age Groups
Internal Carotid Artery Dissection
Fibromuscular Dysplasia
Wounds and Injuries
Sex Characteristics
Connective Tissue
Comorbidity
Neck
Arteries
Smoking
History
Demography
Hypertension
Control Groups

Keywords

  • Anatomy
  • Carotid arteries
  • Computed tomography angiography
  • Dissection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{b04eef482f3944f59092f9064ea3b5e6,
title = "Association between carotid artery tortuosity and carotid dissection: A case-control study",
abstract = "BACKGROUND: Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. METHODS: Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. RESULTS: A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46{\%} of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53{\%} (N.=44) and 34{\%} (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22{\%} (N.=18) of dissection patients and 8{\%} (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23{\%} (N.=38) of dissection patients and 9{\%} (N.=15) of controls (P=0.0009) in the per-vessel analysis. CONCLUSIONS: Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.",
keywords = "Anatomy, Carotid arteries, Computed tomography angiography, Dissection",
author = "Kim, {Sarasa T.} and Waleed Brinjikji and Lehman, {Vance T} and Carrie Carr and Luetmer, {Patrick H} and Charlotte Rydberg",
year = "2018",
month = "8",
day = "1",
doi = "10.23736/S0390-5616.16.03790-5",
language = "English (US)",
volume = "62",
pages = "413--417",
journal = "Journal of Neurosurgical Sciences",
issn = "0026-4881",
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TY - JOUR

T1 - Association between carotid artery tortuosity and carotid dissection

T2 - A case-control study

AU - Kim, Sarasa T.

AU - Brinjikji, Waleed

AU - Lehman, Vance T

AU - Carr, Carrie

AU - Luetmer, Patrick H

AU - Rydberg, Charlotte

PY - 2018/8/1

Y1 - 2018/8/1

N2 - BACKGROUND: Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. METHODS: Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. RESULTS: A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46% of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53% (N.=44) and 34% (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22% (N.=18) of dissection patients and 8% (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23% (N.=38) of dissection patients and 9% (N.=15) of controls (P=0.0009) in the per-vessel analysis. CONCLUSIONS: Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.

AB - BACKGROUND: Carotid artery dissections have long been associated with compromise of the structural integrity of the arterial wall from heritable connective-tissue disorders, hypertension, and trauma. However, an association between spontaneous internal carotid artery dissection and tortuous or redundant carotid anatomy has not been fully explored. METHODS: Patients with CTA confirmed spontaneous cervical internal carotid artery dissections were compared to a group of age and sex matched controls who also received CTA of the neck. Patients with trauma or aortic dissections were excluded. Five radiologists reviewed the CTA images to evaluate internal carotid artery tortuosity (reported as loops, kinks or coils), retrojugular and retropharyngeal courses of the internal carotid artery, presence of fibromuscular dysplasia and presence of atherosclerotic disease. Baseline data collected included demographic characteristics (sex, age, smoking history) and cardiovascular comorbidities. RESULTS: A total of 83 cervical internal carotid artery dissection and their age and sex matched controls were included in this study. 46% of patients were female in each group and mean age was 49.2±10.6 years. The presence of any carotid tortuosity was 53% (N.=44) and 34% (N.=28) in the per-patient analysis of dissection and control groups, respectively (P=0.02). Loops were reported in 22% (N.=18) of dissection patients and 8% (N.=7) of controls (P=0.03). Retrojugular course of the internal carotid artery were seen in 23% (N.=38) of dissection patients and 9% (N.=15) of controls (P=0.0009) in the per-vessel analysis. CONCLUSIONS: Our study suggests that there is an association between the presence of tortuous carotid artery anatomy and spontaneous carotid artery dissection. This finding emphasizes the importance of the presence of tortuous arteries on CTA imaging to increase the index of suspicion for a potential dissection.

KW - Anatomy

KW - Carotid arteries

KW - Computed tomography angiography

KW - Dissection

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U2 - 10.23736/S0390-5616.16.03790-5

DO - 10.23736/S0390-5616.16.03790-5

M3 - Article

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SP - 413

EP - 417

JO - Journal of Neurosurgical Sciences

JF - Journal of Neurosurgical Sciences

SN - 0026-4881

IS - 4

ER -