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Carotid Artery Kinks and Coils
Most anatomic descriptions of the cervical carotid artery note a straight course to the skull base free of branches. Although angulated cervical carotid arteries, especially the internal carotid artery (ICA), are a relatively common finding in adults (∼25%), the excessive elongation of the internal carotid artery in a confined space results in a curvature termed coiling. Kinking of the internal carotid artery also results from elongation of the vessel, but it is defined as an angulation of the vessel of 90 degrees or less. Kinks are often associated with stenoses of the vessel and have been linked with arterial wall degeneration and loss of elasticity. Coiling and kinking of the vessels may also be associated with the formation of an actual looped vessel. This can result in the formation of single or double vessel loops. Metz and colleagues and Weibel and Fields have each proposed a grading system ( Figure 1 ). Togay-Isikay modified and combined these grading systems into a single set of criteria ( Table 1 ).
Classification of kinks according to severity.
TABLE 1
Modified Criteria of Metz and Weibel-Fields by Togay-Isikay
| Malformation | Description |
|---|---|
| Tortuosity | S- or C-shaped elongation or undulation of ICA course |
| Mild kinking | Acute angulation of ICA between segments forming kink ≥60 degrees |
| Moderate kinking | Acute angulation of ICA between segments forming kink 30–60 degrees |
| Severe kinking | Acute angulation of ICA between segments forming kink <30 degrees |
| Coiling | Exaggerated S shape or circular configuration of ICA course |
ICA , Internal carotid artery.
Etiology
Controversy exists as to the possible etiologies of vessel elongation and the resultant conditions. Whether these are sequelae of atherosclerosis, post–carotid endarterectomy changes, fibromuscular dysplasia, age-related degeneration, or simply normal variation or developmental differences remains a matter of debate. Observation of kinks and coils in fetuses and infants support the argument that at least a portion of these phenomena arise from congenital anatomic variation and are not simply acquired. Of note, such an aberrant course and variable location can place the ICA at risk during certain pharyngeal and cervical procedures. The otolaryngology literature discusses tortuous internal carotid arteries manifesting as pharyngeal masses.
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