Posterior Transverse Plication of Tortuous Internal Carotids in Post Stroke Carotid Endarterectomy

Background: Post-operative ICA stenosis secondary to an arterial kinking had been documented in patients who had a tortuous ICA. Posterior transverse plication (PTP) is one of the surgical manoeuvres used during CEA for a significantly tortuous ICA to prevent an arterial kinking stenosis after the carotid surgery. Aim of the study: To highlight the role of PTP in the management of a tortuous ICA and preventing the stenosis from an ICA kinking during CEA.

Methods: We reviewed retrospectively six consecutive patients with symptomatic carotid disease who underwent the PTP during CEA in the presence of a significantly tortuous ICA.

Results: One female and 5 males with a median age of 67 years (range: 65 to 78) years underwent the surgery. None developed any neurological event and post-operative scan did not show any ICA thrombosis or stenosis from an ICA kinking after a median follow-up of 6 months (range: 5 to 17).

Conclusion: We believe that PTA of ICA during CEA is an easy, simple procedure and safe surgical technique with potential benefits in the presence of a significantly tortuous ICA.

Keywords: Carotid; Plication; Tortuous; Kink; Stenosis; Endarterectomy