How Much We Know about Dolicoarteriopathies

Vertebral and carotid artery dolicoarteriopathies, including elongation, kinking, and coiling, are linked to various cerebrovascular dysfunctions. Kinking, categorized by Metz, et al. is graded by angle severity: Grade 1 (90° - 60°), Grade 2 (60° - 30°), and Grade 3 (< 30°). In Grades 2 and 3, reduced blood flow heightens ischemic risk, contributing to hemodynamic instability and cerebrovascular insufficiency. While most symptomatic cases undergo endovascular or surgical correction, some patients with severe kinking remain asymptomatic, questioning current understanding. In 150 cases of carotid or vertebral artery kinking, we observed stenosis in symptomatic patients, differing from the expected arterial enlargement seen in dolicoarteriopathies. This suggests two potential kinking types: stenotic and enlarged. A notable case presented bilateral Grade 3 internal carotid artery kinking, with right-sided stenosis and cerebral hypoperfusion, yet left-sided transient ischemic attacks occurred. This finding challenges existing classifications and suggests further investigation is warranted.