Circulation Journal Vol.72, April 2008

bnormalities of the internal carotid arteries are a com-mon angiographic, magnetic resonance angiogra-phic or Duplex scanning finding and, in the great

majority of cases, they are unrelated to neurological symp-toms. Elongation, coiling and kinking of the internal carotidartery occur in 1025% of the population and while coilingis ascribed to embryological causes, elongation and kinkingare caused by atherosclerosis or fibromuscular dysplasia.

Doppler sonography has gained considerable recognitionas a noninvasive method for detecting carotid artery disease,and power Doppler sonography achieves good color-fillingof all the examined vessels. Dolichoarterial disease of the in-ternal carotid artery occurs in 1025% of the population andis characterized by atypical elongation of the vessel, whichpredisposes to tortuosity, coiling, and kinking. Kinking, themost frequent morphologic anomaly, is characterized bysharp angulation (single and double Z-shaped).

Most patients, as in this case report, are incidentally diag-nosed in an asymptomatic state because of the broad use ofthese noninvasive investigations.

Case ReportAn 85-year-old healthy woman with dyslipidemia under-

went a screening duplex ultrasound scan of the neck vessels.The examination revealed kinking of the left internal carotidartery with a double, narrow, acute angle (Z-shaped), with-out hemodynamic flow changes or atherosclerotic lesions(Fig 1).

DiscussionAbnormalities of the internal carotid arteries are com-

monly disclosed after imaging studies (ie, duplex sonogra-

phy, conventional angiography or magnetic resonanceangiography) and, in the great majority of cases, they areunrelated to neurological symptoms.1

These alterations are characterized by atypical elonga-tion of the vessel, which predisposes it to tortuosity,coiling, and kinking. In the first case, the artery acquires an

Circ J 2008; 72: 682683

(Received September 17, 2007; revised manuscript received October15, 2007; accepted November 1, 2007)Section of Emergency Medicine and Cardiology, Department of Inter-nal Medicine, Livorno Hospital, Livorno, ItalyMailing address: Nicola Mumoli, MD, Section of Emergency Medi-cine and Cardiology, Department of Internal Medicine, LivornoHospital, viale Alfieri 36, 57100 Livorno, Italy. E-mail: nimumoli@tiscali.itAll rights are reserved to the Japanese Circulation Society. For per-missions, please e-mail: cj@j-circ.or.jp

Asymptomatic Carotid Kinking

Nicola Mumoli, MD; Marco Cei, MD

Doppler sonography has gained considerable recognition as a noninvasive method of detecting carotid arterydisease, and power Doppler sonography achieves good color-filling of all the examined vessels. Dolichoarterialdisease of the internal carotid artery occurs in 1025% of the population; these alterations are characterized byatypical elongation of the vessel, which predisposes it to tortuosity, coiling, and kinking, which is the mostfrequent morphologic anomaly and is characterized by sharp angulation (single and double Z-shaped). A patientwith double Z-shaped angulation (kinking) of the left internal carotid artery was incidentally diagnosed in anasymptomatic state because of the broad use of these noninvasive investigations. (Circ J 2008; 72: 682683)Key Words: Carotid arteries; Cerebrovascular circulation; Imaging; Ultrasound

Fig 1. Ultrasound examination show kinking of the left internalcarotid artery with a double, narrow, acute angle (Z-shaped) and noatherosclerotic lesions (A). Power-Doppler sonography achieves agood color-filling of all the examined vessels (B). CCA, commoncarotid artery; ECA, external carotid artery; ICA-K, kinking of inter-nal carotid artery.

A

683Asymptomatic Carotid Kinking

Circulation Journal Vol.72, April 2008

S or C shape; in the second, the elongation is simplymore emphasized and the artery develops 1 or more loops;whereas kinking, the most frequent morphologic anomaly,is characterized by sharp angulation (single and double Z-shaped).2,3

In a series of 469 subjects studied by Del Corso et al,4tortuosities, kinkings, and coilings were more prevalent inthe elderly women (p