Prevalence and morphological changes of carotid kinking and coiling in growth: an echo-color Doppler study of 2856 subje
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ORIGINAL PAPER
Prevalence and morphological changes of carotid kinking and coiling in growth: an echo-color Doppler study of 2856 subjects between aged 0 to 96 years Luigi Di Pino1 · Antonio G. Franchina1 · Serena Costa1 · Stella Gangi1 · Francesco Strano1 · Mario Ragusa1 · Luca Costanzo2 · Corrado Tamburino1 · Davide Capodanno1 Received: 9 March 2020 / Accepted: 1 September 2020 © The Author(s) 2020
Abstract Extracranial internal carotid artery (EICA) kinking and coiling are the most frequently reported carotid anomalies in the literature. Embryogenic and acquired causes for such anomalies have been postulated but the prevalence of kinking and coiling has not been well characterized across age categories. The aim of this study is to evaluate the prevalence of EICA coiling and kinking among different age groups to better understand its potential causes and changes during the course of life.A total of 2856 subjects aged 0 to 96 years were studied by echo-color Doppler (ECD). Morphology and anatomical anomalies of the EICA were assessed. Patients with anatomical anomalies were stratified by age groups and the prevalence of EICA abnormalities was calculated. The maximal velocity recorded at the level of the kinking was compared with that measured in the common carotid artery and the peak systolic velocity kinking ratio (PSVKR) was calculated.A total of 284 subjects (9.94% of the sample) were found to have kinking or coiling of the EICA. The prevalence was significantly higher at the extremes of age (≤ 20 and > 60 years old, p 70%. These guidelines do not indicate the peak systolic velocity ratio as an element for the evaluation of kinking-related stenosis, hence we adapted the definition for the purposes of our study. Regarding the distribution of ICCK across age groups, we found an increasing prevalence in the older age groups (over 50–60 years), which is consistent with the literature [24]. However, to the best of our knowledge, previous studies did not include a pediatric population. This is necessary to support the hypothesis of dynamic changes of EICA dolichoarteriopathies at different ages, if any. In our population, 15.3% of subject under 20 years and 5.2% of subjects of 40 to 60 years old had kinking, supporting the hypothesis of a progressive reduction of kinking prevalence with growth. Due to the design of the study, we do not have follow-up data that substantiate this hypothesis with paired measurements, which warrants a cautious interpretation. Our data show peaks of prevalence in ICCK at the ends in younger and older patients (e.g., 60 years), and a lower prevalence in subjects between 21 and 60 years (Table 2). Similar to Morris et al. who suggest that EICAs anomalies decrease with age [25], we support the notion of ICCK intended as a sporadic congenital condition that with increasing of age and body growth diminishes and/or disappears because of the stretching of the aorta and supra-aortic trunks. To reinforce this idea we show in Figs. 3 and 4 anecdotal images of two children that had been underg
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