Fact-sheet: Carotid artery kinking


Updated on 07/22/2026 at 8:24 AM

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Definition

Tortuous appearance of the internal carotid artery/arteries with carotid angulation <90°.
Normal variant, important to recognize in order to anticipate difficulties during interventional radiology.

Clinical features

Usually asymptomatic

Possible neurologic symptoms: dizziness, tinnitus, ischemic stroke

Ultrasound

Morphologic evaluation and angular measurement on B-mode

Evaluation of hemodynamic impact on pulsed Doppler

CT

CT angiography of the supra-aortic trunks

Angulation between internal carotid artery segments < 90°, and Metz classification (see below)

Value of 3D reconstructions

Classification

Metz classification:

  • Type 1: angle < 90°
  • Type 2: angle < 60°
  • Type 3: angle < 30°

Internal carotid artery Kinking classification Kinking artère carotide interne Radeos

Differential diagnosis

  • Coiling of the internal carotid artery: 360° loop.
  • "C"-shaped or "S"-shaped loop of the internal carotid artery.