Tortuosity, coiling, and kinking of the internal carotid artery

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Abstract
Symptoms rarely occur when coiling is present unless atherosclerotic occlusive disease is also present in the carotid arteries or the vertebrobasilar system. Cerebrovascular insufficiency associated with kinking is most likely precipitated when collateral circulation fails because of diffuse atherosclerosis, extrinsic compression of vertebral arteries, anomalies of the circle of Willis, alteration of position of head and neck, variation of blood pressure, or irregularities of heart rate. It is emphasized that the angiographic study must include the entire vascular tree supplying the brain and that several views must be taken with the head and neck in different positions. Without this kind of complete information, it is unwarranted to conclude that a surgical operation on the coiled or kinked segment is indicated or will afford any significant benefit to the patient.

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