Clinical presentation and impact of internal carotid artery kinking in children

Introduction:
The internal carotid artery (ICA) is the principal source of blood supply to the brain, eye, and internal ear. A wide spectrum of clinical symptoms associated with dolichoarteropathy of that vessel has been described, with kinking being the most frequently reported and clinically relevant type of carotid abnormalities of the geometrical course of the vessel. The aim of the study was to analyze the clinical picture of ICA kinking in children.

Material and methods:
We retrospectively analyzed all pediatric patients hospitalized in our department with various indications from January 2021 to December 2023, by consulting all of the clinical records in search for those whose imaging tests revealed ICA kinking. Nineteen children with a confirmed diagnosis of ICA kinking were identified. Among all patients with detected ICA kinking, 13 (68.4%) at the time of admission presented with signs and symptoms that could be attributed to insufficient cerebrovascular circulation due to an anatomical abnormality of the ICA. The remaining 6 (31.6%) children were admitted for various clinical reasons and did not present symptoms that could have been linked with abnormal cerebral perfusion.

Results:
Thorough medical history, clinical presentation, and associated features of patients are reported, and a discussion in light of previously published papers on the subject is presented.

Conclusions:
We emphasize the importance of anamnesis and clinical awareness in any case of a pediatric patient with transient non-specific neurological manifestations that could suggest anomalies of ICA. An appropriate diagnostic approach can help to reduce possible risk, minimalize costs and guide personalized management of these patients.