Clinical Outcomes of Microsurgical Flow Reconstruction in Long-Segment Cervical Internal Carotid Artery Stenosis with Distal Grade 2 or 3 Kinking.

BACKGROUND

To evaluate the clinical outcomes of perivascular sympathectomy-assisted arteriolysis combined with kinking correction in patients with long-segment cervical internal carotid artery (ICA) stenosis accompanied by Grade 2 or 3 distal kinking.

METHODS

Nineteen patients with symptomatic, nonatherosclerotic, ≥ 5 cm-long tubular ICA stenosis and distal kinking (Grade 2 or 3) underwent microsurgical decompression between 2017 and 2023. Surgical intervention included circumferential arteriolysis, perivascular sympathectomy, and correction of the kinking. Clinical symptoms such as hemiparesis, dysphasia, seizures, migraine, and tinnitus were assessed preoperatively and postoperatively up to 24 months. Radiological outcomes were evaluated using computed tomography/magnetic resonance angiography and perfusion imaging. Preoperative and postoperative vessel diameters were measured intraoperatively. The analysis used SPSS and statistical significance was set at P < 0.05.

RESULTS

Significant postoperative symptom resolution was observed in hemiparesis (100%), motor dysphasia (100%), migraine (88.9%), and seizures (83.3%). Intraoperative diameter of the ICA increased by 1.5-2-fold following sympathectomy (mean preoperative diameter: 3.4 mm; postoperative: 7.5 mm; P < 0.001). Perfusion imaging demonstrated improved cerebral blood flow in the affected vascular territory in all patients.

CONCLUSIONS

Microsurgical flow reconstruction using arteriolysis and perivascular sympathectomy with kinking correction is a promising technique for selected patients with complex cervical ICA stenosis not amenable to endovascular treatment. It achieves significant symptomatic relief and improves hemodynamic parameters without major complications.