S-shaped tortuosity of both all. Pathological tortuosity of arteries
Under tortuosity of the carotid and vertebral arteries This implies deformation, abnormal weaving or curvature.
Usually, similar phenomena are innate. The heredity of the pathology lies in the predominance of elastic fibers over collagen, as a result of which the walls of the arteries wear out faster and begin to deform. Also, pathological tortuosity of the carotid arteries can develop as a result, for example, of long-term hypertension or atherosclerosis.
The definition of “pathological” refers to the threat that arterial tortuosity can pose to human health and life. Obstruction of blood supply due to pathological deformations of the carotid and vertebral arteries leads to the development of a threat stroke.
Types of disease
The following types of pathological tortuosity of the carotid and vertebral arteries are distinguished:
- artery lengthening . The most common prolongation of the internal carotid or vertebral artery, which leads to the formation of bends along the vessel. An elongated artery rarely causes concern and is often discovered only during random examination. With age, the elasticity of the arterial wall changes, and the bends of the artery can become kinks, with the development of disorders cerebral circulation;
- kinking - bending of the artery at an acute angle. Kinking can be congenital, but the appearance of kinks can also be promoted by arterial hypertension or progressive atherosclerosis in the internal carotid artery. Kinking of the carotid artery appears transient disturbances cerebral circulation. With kinking of the vertebral artery, vertebral-basilar insufficiency develops (a reversible disorder of brain function caused by a lack of blood supply);
- coiling - formation of a loop of the carotid or vertebral artery, leading to significant changes in blood flow in it. The nature of the bends during coiling can vary depending on the position of the body, blood pressure. The blood flow becomes chaotic, which leads to a decrease in blood pressure after the loop and, accordingly, to a decrease in blood supply to the brain.
Symptoms
The symptoms of pathological tortuosity of the carotid and vertebral arteries are varied. The most common symptoms are:
- so-called transient ischemic attacks (temporary interruptions in blood supply), accompanied by temporary paralysis upper limbs, speech disorders, temporary blindness;
- noise in the head, dizziness;
- migraine attacks;
- impaired coordination of movements, falls without loss of consciousness;
- short fainting spells.
Diagnosis and treatment
Diagnosis of pathological tortuosity of the carotid and vertebral arteries is carried out using echo scanning with Doppler ultrasound and spectral analysis of the received signal. At the stage when the symptoms of pathological tortuosity of the carotid and vertebral arteries become obvious, X-ray contrast angiography is also used.
Treatment of pathological tortuosity of the carotid and vertebral arteries is carried out by surgical intervention in a hospital setting. Such an operation usually does not last long and effectively cures the pathology in 99% of cases. More long-term treatment may require hypertension and atherosclerosis, if these diseases caused the development of pathological tortuosity of the carotid and vertebral arteries.
Development ultrasound diagnostics vascular diseases of the brain has changed the understanding of the prevalence and significance of pathological tortuosity (PI) of the carotid arteries as a cause of cerebrovascular accidents. As a cause of cerebrovascular accident in adults, pathological tortuosity of the internal carotid arteries (ICA) is second only to atherosclerotic lesions in prevalence.
A feature of the diagnosis of pathological tortuosity of the ICA is the possibility of detection during a standard ultrasound examination.
Currently, there is no generally accepted terminology to indicate violation of the straightness of the ICA. In the domestic literature, the most widely used term is “pathological tortuosity of the carotid arteries,” proposed by E.V. Schmidt in 1975. This designation of violations of the straightness of the ICA has a deep clinical and pathophysiological basis, since it characterizes various options deformations of the ICA from the standpoint of their clinical significance. The use of this term implies not only the designation of the disturbed geometry of the ICA, but also the significance of the incorrect course of the ICA in the formation of cerebral hemodynamic disorders with a certain clinical picture.
There is no generally accepted classification of pathological tortuosity of the ICA. The most widely used classification is pathological forms BCA proposed by J. Weibel and W. Fields. The authors distinguish three types of ICA deformation, designating them as tortuosity, coiling, and kinking. Tortuosity means S- or C-shaped deformity ICA (Fig. 1, 2) without sharp angles and visible blood flow disturbances. The authors consider this type of ICA deformity to be congenital and hemodynamically insignificant.
Rice. 1. C-shaped tortuosity of the internal carotid artery (ICA) in color duplex scanning (CDS) mode.
Rice. 2. C-shaped tortuosity of the ICA in B-mode (a) and CD (b).
Looping (“coiling”) is characterized by a congenital circular deformity with the formation of a loop (Fig. 3), which can lead to impaired cerebral circulation.
Rice. 3. Loop-shaped tortuosity of the left (a) and right (b) ICA in the CD mode.
Kinking is understood as acquired, hemodynamically significant angulation of the ICA with stenosis of its lumen (Fig. 4).
Rice. 4. Loop-shaped tortuosity of the ICA with kinking in the CDS mode (a) and schematically (b).
Color duplex scanning(CDS) allows not only to assess the shape of the tortuous carotid artery, but also to characterize in detail the state of hemodynamics. In accordance with this, all types of violation of the straightness of the ICA can be divided into “hemodynamically significant” and “hemodynamically insignificant”.
Introduction into clinical practice of modern ultrasonic methods diagnostics indicates high prevalence pathological tortuosity of the ICA. According to F. Koskas et al. , the tortuous course of the carotid arteries occurs in 10-43% of cases in patients with cerebrovascular accidents. It is important that the frequency of detection of pathological tortuosity of the ICA in adults ranked second after atherosclerosis of the carotid arteries. A study conducted by V.P. Kulikov et al. showed that among the patients in whom pathological tortuosity of the carotid arteries was identified based on the results of CDS, there were slightly more women (56.1%) than men (43.9%), pathological tortuosity of the right ICA was more often diagnosed (42.3%) Compared to the left (25.1%), 32.6% had bilateral tortuosity. Thus, it was shown that pathological tortuosity of the ICA is a common pathology not only in patients, but also in the population.
The etiology of pathological tortuosity of the ICA has not been definitively established. Today, there are two points of view on the causes of pathological tortuosity of the ICA - both congenital and acquired pathology.
Congenital genesis is supported by the detection of deformed carotid arteries in young patients in the absence of atherosclerotic process in the vessels, and frequent bilateral damage to the carotid arteries.
In favor of acquired character pathological deformation ICA may be evidenced by the higher frequency of detection of this pathology with age and the dependence of the severity of the carotid artery bend on age and blood pressure level.
Pathological tortuosity of the ICA in clinical manifestations resembles the symptoms of atherosclerotic stenosis of the ICA and is manifested by signs of cerebrovascular accident. Most often, deformation of the carotid arteries is combined with arterial hypertension and atherosclerosis. Generally clinical manifestations pathological tortuosity of the ICA is not very specific. Local signs of pathological tortuosity have some specificity, including pathological pulsation in the neck, signs of compression of the hypoglossal, accessory and vagus nerves.
However, most symptoms and syndromes are nonspecific. The most common pathological tortuosity of the ICA is motor impairment, blurred vision, headaches, speech impairment, dizziness, loss of consciousness, noise and ringing in the ears, pain in the neck, and epileptiform seizures.
Lack of specific clinical signs pathological tortuosity of the ICA significantly complicates the identification of this pathology based on the results of a clinical examination.
Detection of pathological tortuosity of the ICA in connection with its low-specific clinical manifestations is possible only with the help of specialized instrumental methods diagnostics Given the limitations of radiocontrast angiography and magnetic resonance angiography, the main method for detecting ICA deformity is CD. This method combines the ability to visualize vessels and blood flow in them with the study of the nature and quantitative parameters of blood flow.
Ultrasound criteria for hemodynamic disturbances in pathological tortuosity of the ICA are recorded by Doppler methods locally - in the zone of vessel tortuosity. These violations can be recorded using different options and in .
Typical picture of pathological tortuosity of the ICA various shapes in the CDS mode is shown in Fig. 3-6. The CDS method makes it possible to characterize in detail the shape of tortuosity, its localization and identify disorganization of blood flow. The criteria for the local hemodynamic significance of pathological tortuosity of the ICA are: gradient of peak systolic blood flow velocity between the proximal and distal sections of the vessel in relation to the site of tortuosity with a decrease in velocity in the distal direction by 20% or more; an increase in peak velocity at the site of angulation compared to the proximal portion of the ICA by 30% or more; disorganization of blood flow in the tortuosity zone, manifested by an increase in spectral expansion and disruption of the blood flow pattern in the mode; the presence of asymmetry in the peak blood flow velocity in the distal section of the tortuous artery compared with the same section of the unchanged contralateral ICA. Thus, from the data presented above it follows that one of the links in the pathogenesis of cerebral circulatory disorders in pathological tortuosity of the ICA is a local disturbance of hemodynamics in the tortuosity zone with a decrease in blood flow in the distal direction.
Rice. 5. Loop-shaped tortuosity with kinking from the mouth and high-lying S-shaped tortuosity of the ICA in the CDS mode.
Rice. 6. S-shaped pathological tortuosity of the ICA in the CD mode (a, b).
A retrospective analysis of the medical records of 36 patients at the clinic with pathological tortuosity of the ICA subsequently diagnosed according to the CDS data showed that neurologists in outpatient setting clinical diagnosis chronic disorder cerebral circulation was established in 18.9% of cases, acute cerebrovascular accident - in 6.7%, cerebral angiodystonia - in 16.4%, cervical osteochondrosis - in 10.1%, consequences of traumatic brain injury, intracranial hypertension, cephalalgia, hypertension - in 18.2% of cases. Patients referred for examination without clinical diagnosis, in whom pathological tortuosity of the carotid arteries was discovered during CDS, amounted to 29.7%.
Moreover, to assess the informativeness of CD in diagnosing pathological tortuosity of the ICA, we analyzed the medical records of 9 patients who underwent angiography and surgical treatment. Concordance of the results regarding the presence of pathological tortuosity of the ICA was noted in 100% of cases. However, discrepancies were also found in the assessment of the shape and location of tortuosity. Obviously, the reason for the discrepancies is the lack of a generally accepted classification of pathological tortuosity of the ICA and clear assessment criteria for both the form and localization of tortuosity.
Currently, pathological tortuosity of the ICA can be the cause of transient and persistent cerebrovascular accidents. With modern ultrasound equipment, diagnosing pathological tortuosity of the ICA is not technically difficult and the main method is primarily CD.
Literature
- Vascular diseases nervous system/ Ed. E.V. Schmidt. M.: Medicine, 1975. 663 p.
- Weibel J., Fields W.S. Tortuosity, coiling and kinking of the internal carotid artery. I Etiology and radiographic anatomy // Neurology. Minneap, 1965. V. 15. P. 7-18.
- Koskas F., Kieffer A., Kieffer E. et al. Loops and folds of the carotid and vertebral arteries: indication for surgery // J. Malad. Vascul. 19 Supl. A. 1994. P. 51-54
- Kulikov V.P., Khoreyev N.G., Gerasimenko I.N. and others. Color duplex scanning of vessels in the diagnosis of pathological tortuosity of the carotid arteries // Echography. 2000. N 2. S. 147-154.
Advantages of treatment at the Innovative Vascular Center
Vascular surgeries at our clinic have significant experience unique operations on the carotid arteries with pathological tortuosity. The main problem for surgical treatment is to determine clear indications for surgical treatment. Our clinic has developed a clear diagnostic protocol that allows us to determine clinical significance one or another tortuosity and the degree of its influence on cerebral blood flow. The experience of successful operations in our clinic for pathological tortuosity exceeds 200 cases.
Causes and prevalence of pathological tortuosity
Pathological tortuosity always develops due to the elongation of the internal carotid artery, which is forced to fold into bends or even loops. Excessive length of the internal carotid artery is often formed during embryonic development, that is, the tortuosity of the artery is most often congenital. With age, further twisting of the redundant carotid artery into a loop may occur. According to some researchers, pathological tortuosity may be the cause of neurological and intellectual problems in children of preschool and primary school age.
Lengthening of the internal carotid artery can also develop as a result of neglected hypertension, when persistently high blood pressure causes changes in the artery wall and its bends. Such tortuosity rarely affects cerebral hemodynamics and is more often a phenomenon detected incidentally by ultrasound of the great arteries.
Pathological tortuosity of the carotid arteries was detected in 16% of patients who died from ischemic stroke, more than 23% of children who suffered ischemic stroke had pathological tortuosity. When examining patients undergoing treatment for cerebrovascular accidents, pathological tortuosity was detected by ultrasound angioscanning in 12%. Various disorders of the internal carotid arteries, according to pathological studies, were identified in 40% of people.
Clinical forms
Lengthening the artery. The most common is elongation of the internal carotid or vertebral artery, which leads to the formation of smooth bends along the course of the vessel. An elongated artery is rarely a cause of concern and is usually discovered during random examination. Important Lengthening the artery is of concern to ENT doctors, since the wall of the artery may be abnormally close to the palatine tonsils and may be accidentally damaged during tonsillectomy. With age, the elasticity of the arterial wall changes and smooth bends of the artery can become kinks, with the development of a picture of cerebral circulation disorders. When arteries are lengthened without kinks, ultrasound examination of blood flow does not detect any disturbances.
- bending of the artery at an acute angle. Kinking can be congenital, when cerebral circulation disorders are detected from early childhood and develop over time from an elongated carotid artery. The formation of kinks is promoted arterial hypertension, progression of atherosclerosis in the internal carotid artery. Clinically, kinking of the internal carotid artery is manifested by transient disturbances of cerebral circulation. With kinking of the vertebral artery, vertebrobasilar insufficiency develops. Detection of kinking with brain symptoms the question arises about surgical correction tortuosity.
- formation of an artery loop. Despite the smooth movement of the loop, changes in blood flow in it are very significant. The nature of the bends during coiling may change depending on body position and blood pressure. A chaotic nature of the blood flow is observed, which leads to a decrease in blood pressure after the loop and, accordingly, to a decrease in blood flow through the cerebral arteries. If a person has a well-developed circle of Willis on the lower surface of the brain, then he will never know about the existence of a loop or inflection. The appearance of symptoms of cerebral circulatory failure indicates disturbances in blood flow compensation and dictates the need for detailed examination and treatment.
Complaints and symptoms
Manifestations of pathological tortuosity are varied, the most common are:
- A picture of transient ischemic attacks in the blood supply of a tortuous artery with temporary paralysis of half the body or arm (hemiparesis), speech impairment, etc.);
- Temporary blindness in one eye;
- Noise in the head;
- Dizziness;
- Flashing before the eyes;
- Headaches without clear localization;
- Short-term loss of consciousness;
- Falls without loss of consciousness;
- Temporary imbalances;
- Migraine-like attacks.
Course and complications
If tortuosity of the carotid artery becomes symptomatic, then it is quite painful for the patient. Minor signs and symptoms of the disease gradually intensify and lead to decreased ability to work. The presence of pathological tortuosity can lead to symptomatic hypertension, which in turn contributes to the progression of tortuosity and the formation of kinks. In places where the carotid artery is bent, adhesions can form, which further disrupts the nature of blood flow, making it turbulent. As a result, these processes can lead to transient ischemic attacks or stroke.
ICA tortuosity is present in any healthy person. The structure of this cerebral blood vessel is such that it follows the relief of the neck and inner surface cranium(in a limited area). Tortuosity of the ICA within physiological norm does not give pronounced clinical manifestations. But pathological tortuosity of the ICA always entails a violation of cerebral blood supply.
First signs oxygen starvation may begin to appear on early stage diseases. This frequent attacks dizziness with dysfunction vestibular apparatus. At such moments, patients note a sharp decrease in visual acuity (everything begins to blur before their eyes), the appearance of tinnitus and an attack of nausea.
Tortuosity of the internal carotid artery is dangerous condition, since this blood vessel is quite large. It is paired - present with the left and with right side. Left artery originates from the aorta. The right blood vessel starts from the brachial trunk. When passing through the clavicle area, bifurcation (division) occurs into internal and external artery. The external carotid artery is perfectly palpable on the side of the neck in the very center. If you press your fingers, you can feel the pulsation in time with the crushing of the myocardium.
The internal carotid artery goes deep into the muscle tissue and expands in the form of an ampulla. The carotid sinus is located here. This is a large collection of neurons. They are responsible for regulating the level of muscle wall tension blood vessels. Thus, they have a direct effect on blood pressure levels. Therefore, pathological tortuosity of the internal carotid artery is often the cause of the development of arterial hypertension. In children and adolescents this manifests itself as vegetative-vascular dystonia according to the hypertensive type.
The second direction of influence of this reflexogenic zone is the work of the myocardium. At pathological changes abnormalities may be observed in the internal carotid artery heart rate, development of ischemic area. Also, the composition may vary greatly among patients. arterial blood and the percentage of oxygen in it. The carotid sinus is also responsible for this process.
Pathological tortuosity of the ICA on both sides: what does it mean?
Tortuosity of the ICA on both sides is a common vascular pathology. It is found in approximately every fourth adult. Even if a diagnosis has not been established, but there are clinical manifestations, such a deviation should be suspected.
Pathological tortuosity of the ICA on both sides can occur in both early childhood, and in adulthood. There are cases where pathology began to form in old age. In such patients, the disease is discovered randomly when clinical diagnostics atherosclerosis of cerebral vessels.
It is important to understand what tortuosity of the ICA on both sides means for the state of brain structures and preservation general health. This pathology is not harmless. Constant monitoring by a doctor and comprehensive treatment are required.
Of course, it is unlikely that it will be possible to restore the completely normal position of the carotid arteries. But with the help of methods manual therapy, gymnastics, reflexology can restore the conductivity of blood vessels and compensate for their partial incorrect position.
Apply pharmacological preparations We do not recommend it for the purpose of expanding the vascular bed. It doesn't last long positive result and often leads to the development of undesirable side effects.
If you need treatment for ICA tortuosity, you can make a free appointment with chiropractor in our clinic. He will conduct a full examination, diagnose accurate diagnosis and will talk about the prospects for using techniques to treat pathology in your individual case.
Among the potential causes of the development of pathological tortuosity of the internal carotid arteries, doctors name the following negative factors:
- congenital deformations of connective tissue, which is designed to fix blood vessels;
- genetic hereditary predisposition;
- predominantly the predominance of the quantitative content of elastic tissue fibers over collagen;
- wear and tear of the walls of blood vessels and their deformation under the influence of nicotine and alcohol breakdown products (smoking and drinking alcoholic drinks is a primary risk factor in the development of ICA tortuosity);
- in adults, the cause may be arterial hypertension of the renal, essential or atherosclerotic type;
- in adolescents, tortuosity is provoked sharp jumps blood pressure and vascular fullness against the background of vegetative-vascular dystonia;
- weakness of the neck and collar muscles;
- atherosclerotic changes in blood vessels cerebral vessels;
- cervical osteochondrosis and poor posture in the form of straightening physiological lordosis;
- disruption of the innervation process during radicular syndrome;
- posterior vertebral artery syndrome;
- deformation of the uncovertebral joints of the spine;
- various injuries;
- increased body weight and sedentary lifestyle life;
- sedentary work with neck muscle tension;
- improper organization of sleeping and working spaces.
Identifying and eliminating all potential causes of pathological tortuosity of the internal carotid artery is a primary task for the doctor who will develop individual plan patient treatment. Therefore, it is extremely important to provide the doctor with reliable information when collecting anamnesis. The more accurately the cause of tortuosity is determined, the higher the chances of a full recovery.
S and C shaped tortuosity of the internal carotid artery
There are several types of pathology. More common is the s-shaped tortuosity of the ICA with a smooth transition from one dislocation site to another. Usually with this type there is a deviation at two points. Most often, s-tortuosity of both ICAs is formed during deformities cervical region spine. Straightening the cervical lordosis and static overstrain of the neck muscles entails a change in the position of the bed of this cerebral vessel.
S-shaped tortuosity of the internal carotid artery in most cases does not give pronounced clinical manifestations. It is discovered during a study for another disease. If left untreated for 2-3 years, the disease will progress. In this case, it increases clinical picture, required emergency treatment vascular pathology.
C-shaped tortuosity of the internal carotid artery develops in people suffering from high blood pressure. This type is typical for elderly patients suffering from atherosclerosis of cerebral blood vessels.
Children and adolescents are characterized by this type of pathology called kinking. This is a bend of the cerebral blood vessel at an angle of 45 degrees. It is a congenital vascular pathology. Gives attacks acute disorder cerebral circulation with excessive physical activity. Such children and adolescents often complain of attacks of dizziness and lightheadedness during physical education lessons. Parents should pay attention to the appearance of such complaints and conduct an examination.
Hemodynamically significant tortuosity of the ICA with local disruption
Any significant tortuosity of the ICA gives pronounced clinical manifestations and significantly reduces the patient’s quality of life. Decline mental performance, progression of dementia, inability to successfully complete training - these are only some of the potential problems.
Hemodynamically significant tortuosity of the ICA can provoke the appearance of attacks of cerebrovascular accident. With prolonged ischemia of areas of the brain, a focus of necrosis is formed. This is a cerebral infarction, which can lead to disability due to the appearance of persistent paralysis of the facial muscles, lower and upper extremities.
The least dangerous is the tortuosity of the ICA with a local disturbance of hemodynamics - with this pathology the patient feels constant drowsiness, decreased performance, deterioration in the quality of night sleep. Mild paresis of the muscles of the upper and lower limbs on the side opposite to the affected vessel.
Moderate loop-like tortuosity of the ICA
The loop-like tortuosity of the ICA is called coiling. This pathology has a very significant impact on hemodynamics. The loop can close at a certain moment, this provokes a sharp cessation of blood supply to a large part of the brain.
Even moderate form ICA tortuosity of the coiling type requires constant monitoring by a doctor. When the first signs of insufficiency of cerebral blood supply appear, it is imperative to begin treatment.
Please note the following clinical symptoms of this vascular pathology:
- regularly occurring attacks of dizziness with nausea;
- headache tension (occurs at the end working day);
- orthostatic dizziness;
- disruption of the vestibular apparatus, which is expressed in discoordination of movements of the arms and legs;
- nystagmus of the pupils of the eyes without other signs of brain injury;
- whistling, rustling, pulsation and other types of extraneous sounds in the ears;
- fainting and confusion during severe physical exertion;
- constant fatigue, drowsiness and decreased mental performance.
For the diagnosis of vascular pathology of this type You can use Doppler ultrasound and ecoscanning, spectral analysis of the structure of the carotid artery, computer and magnetic resonance tomography, angiography using an X-ray machine with preliminary administration of a contrast agent.
Treatment of tortuosity of the internal carotid artery (ICA)
Treatment of ICA tortuosity must begin at an early stage. You should not wait until an attack of cerebrovascular accident occurs. As soon as pathological tortuosity of the internal carotid artery is diagnosed, treatment begins using manual therapy techniques. Electromyostimulation of the neck muscles allows you to normalize posture and the state of cervical lordosis. With the help of reflexology, there is an impact on internal state blood vessels, blood pressure levels are normalized.
The doctor develops an individual course of therapy. It may include therapeutic exercises and kinesiotherapy, osteopathy and massage, reflexology and physiotherapy. Good results shows traction spinal column, especially if the ICA syndrome is associated with the development cervical osteochondrosis and its complications.
Pathological tortuosity and elongation of the extracranial section of the main arteries of the brain in 15–20% of cases are the cause of discirculation in the carotid and vertebrobasilar areas.
Pathological tortuosity of arteries
People speak out about the origin of pathological tortuosity various points vision. In cases where elongation and tortuosity of the artery are found in at a young age, a more reliable assumption about the congenital nature of the pathology, especially since it is combined with anomalies of the cerebral vessels (aneurysms, hypoplasias, anomalous structure Circle of Willis). In 25% of cases, tortuosity of the vertebral artery is combined with development options in the form of their departure from the aortic arch, high (at the level of C3–C5 vertebrae) entry into the bone canal, and lateral displacement of the orifice. In this case, excessive elongation of the vertebral artery is sometimes observed, as a result of which conditions are created for kinks or compression by the neck muscles.
However, in most cases these changes are acquired. This is already indicated by the fact that this pathology is much more common in older people. The main role in its occurrence is apparently played by age-related changes blood vessels, especially in combination with long-standing arterial hypertension.
Forms of pathological tortuosity
According to angiography, three main forms of pathological tortuosity are distinguished:
- “C”- and “S”-shaped extensions;
- looping;
- kinks.
There is a classification by M. Ciccone, which is based on differences in the angle between the theoretical axis of the vessel and its real direction:
- 45–89 degrees - tortuosity (bending);
- 90–120 degrees - kinking (loop formation);
- more than 120 degrees - coiling (bending at an acute angle).
The presence of significant bends, loops of bends at an acute angle can impede blood flow through the vessel directly, as well as as a result of the occurrence of turbulence (turbulence) in the area of bends, leading to the formation of functional stenosis. The degree of obstruction of blood flow changes with different positions of the head, as well as with changes in the level of blood pressure, a decrease in which can increase the degree of inflection. As a rule, several arteries are tortuous in one form or another.
Clinical picture of the disease
The clinical picture of the disease is usually determined by:
- localization of tortuosity (carotid or vertebrobasilar region);
- its hemodynamic significance;
- state of collateral circulation.
Diagnostics
Until recently, the only way to diagnose pathological tortuosity was radiocontrast angiography. Wide Application methods ultrasound examination V clinical practice made it possible to non-invasively detect this pathology. The method makes it possible to detect tortuosity in cases where it is not possible to trace the course of the artery along its entire length in one plane; in this case, discontinuity of its contours and a change in the spectrum in the form of turbulence are usually observed. A special advantage of DS is that the method makes it possible to identify atherosclerotic plaques, the development of which is stimulated by the turbulence of the blood flow in the zone of maximum bending of the artery. The information content of the method especially increases when using the color flow mode. In the area of a long-term arterial bend, septal stenosis may form due to fixation of the artery walls inside the bend.
Combination of visualization method and spectral analysis Doppler frequency shift allows you to assess the nature of blood flow and the hemodynamic significance of the pathology. Signs of local hemodynamically significant tortuosity should be considered:
- increased peak velocity (frequency) of blood flow;
- changing the shape of the Doppler spectrum curve;
- pronounced spectral expansion in the inflection area, flow turbulence;
- slowing down the blood flow rate distal to the bend.
The absence of these signs indicates that the pathology has no hemodynamic significance.
To assess the systemic significance of tortuosity (at the level of the circle of Willis), the presence or absence of a decrease in the linear velocity of blood flow in the ipsilateral MCA is determined. The disadvantage of DS is the difficulty, and sometimes impossibility, of diagnosing pathological tortuosity of the ICA, located high at the entrance to the skull.
