text: Management of the tortuous internal carotid artery.
  The tortuous internal carotid artery as the basis of cerebral vascular insufficiency is a controversial entity, as such lesions frequently occur without neurologic symptoms. However, some tortuous vessels are associated with significant carotid atherosclerotic disease requiring a specific surgical approach. This formed the basis of our report. Symptoms of cerebrovascular insufficiency in association with a tortuous internal carotid artery was encountered in 27 of 853 carotid endarterectomies over a 22 year period. Stenosis of hemodynamic significance was noted in nine patients and irregularities or ulceration were noted in the rest. With the standard technique of carotid endarterectomy, removal of plaque from a tortuous vessel leads to loss of the stenting effect provided by the plaque such that angulation occlusion is likely to occur. The optimal reconstruction in our experience is eversion endarterectomy by transection and lower reimplantation of the internal carotid artery on the common carotid artery. Our experience with 17 such procedures in 15 patients has been presented.
  
entities.text: ['tortuous internal carotid artery']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T1
entities.text: ['tortuous internal carotid artery']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T2
entities.text: ['cerebral vascular']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T3
entities.text: ['lesions']
entities.type: Pathological_formation
entities.entity_id: PMID-3993849_T4
entities.text: ['tortuous vessels']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T5
entities.text: ['cerebrovascular']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T6
entities.text: ['tortuous internal carotid artery']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T7
entities.text: ['carotid']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T8
entities.text: ['carotid']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T9
entities.text: ['tortuous vessel']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T10
entities.text: ['plaque']
entities.type: Cell
entities.entity_id: PMID-3993849_T11
entities.text: ['plaque']
entities.type: Cell
entities.entity_id: PMID-3993849_T12
entities.text: ['internal carotid artery']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T13
entities.text: ['common carotid artery']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T14
entities.text: ['carotid']
entities.type: Multi-tissue_structure
entities.entity_id: PMID-3993849_T15
entities.text: ['neurologic']
entities.type: Anatomical_system
entities.entity_id: PMID-3993849_T16