After a six-week course in the hospital under palliative care, she eventually expired due to cardiopulmonary arrest.Ī 66-year-old female presented to the emergency department following two episodes of dizziness and nausea associated with a sudden movement of the head. Subsequently, the patient’s family elected to make her not resuscitate or intubate, and limited medical intervention status. The patient did not meet the criteria for thrombolysis due to being on anticoagulation, and neurosurgery was not pursued due to her age. The right internal and external carotid arteries resumed their ordinary course. This incidental finding did not contribute to the patient's symptoms. The arrow points to the tortuous right common carotid artery that comes in close proximity to the left. Tridimensional reconstruction of kissing carotids. The cases presented in this report highlight the etiologies and clinical implications of these rare variants. We present two rare cases of carotid artery tortuosity: the first is an asymptomatic tortuous right common carotid artery with the appearance of “kissing carotid arteries.” The second case is a symptomatic patient with a kinked left internal carotid artery. However, they may have clinical implications, including mass effects, ischemic symptoms, and an increased risk of procedural complications. Previous studies have shown that these variants are often incidental findings. Although both are rare (incidence 18-34%), tortuosity of the ICA is more common. When this phenomenon occurs bilaterally in the ICA, it is commonly referred to in the literature as retropharyngeal ICA or “kissing carotids,” where the carotid arteries course medially. Carotid artery tortuosity is an anatomic variant where a segment of the internal carotid artery (ICA) or common carotid artery (CCA) is elongated and redundant, presenting as coiling, looping, or kinking.

Carotid artery ultrasound