Evaluation of Tortuosity of Extracranial Vessels

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Abstract
Three hundred consecutive cases of 4-vessel angiography were reviewed for evidence of tortuosity of the extracranial vessels, widening of the carotid bifurcation angle, clinical evidence of cerebrovascular disease, angiographic evidence of atherosclerosis, and the presence of hypertension. Measurement of vessel tortuosity and carotid bifurcation angle depended to some degree on the relationship of the vessels to the X-ray beam. Although the X-ray projection could reduce the apparent degree of tortuosity or width of the bifurcation angle, in no case could it increase the measurements. Measurements were, therefore, made on those radiograms that showed the greatest tortuosity or widened angle. Sex of the patients did not seem to be a significant factor in the degree of vessel tortuosity, abnormal widening of the carotid bifurcation angle, atherosclerosis, or hypertension. Degree of carotid and vertebral artery tortuosity, widened bifurcation angle, atherosclerosis, and hypertension all progressively increased with age. Tortuosity of the extracranial vessels, however, was also seen in young patients, the most common site being in the cervical internal carotid artery anterior to the atlas. In contrast, tortuosity of advanced age was generally seen just above the carotid bifurcation and frequently associated with a widened bifurcation angle. If similar age groups were evaluated, there did not appear to be a significant increase in tortuosity between those individuals clinically determined to have cerebrovascular disease and the control subjects. As a corollary, tortuosity of the extracranial vessels and a widened bifurcation angle were seen frequently in patients investigated for causes other than cerebrovascular disease. There was significant correlation between tortuosity of the extracranial vessels and atherosclerosis or hypertension. There was a significant correlation between a widened bifurcation angle and atherosclerosis but not hypertension.