HEDS and Carotid Artery Tortuosity Causes and Prevalence

Unsplash Photo

Carotid artery tortuosity is a condition where the carotid arteries, which supply blood to the brain, become twisted or curved more than usual. This can affect blood flow and sometimes lead to symptoms like dizziness or stroke risk. One factor linked to this condition is HEDS, or hypermobile Ehlers-Danlos syndrome, a connective tissue disorder. I am aware of carotid tortuosity because my mom has been diagnosed with it. Hers is not severe. It is being monitored. But when I was told about it I didn't think that twisting arteries was even a "thing". Understanding what causes carotid artery tortuosity and how common it actually is, especially in people with HEDS, can help patients and healthcare providers better manage risks.

Carotid artery tortuosity happens when the artery bends or twists excessively. Several factors can cause this:

• Genetic connective tissue disorders: Conditions like HEDS weaken the structural support of arteries, making them more prone to twisting.

• Aging: As people age, arteries can lose elasticity and become more tortuous.

• High blood pressure: Increased pressure inside arteries can cause them to elongate and twist.

• Anatomical variations: Some people naturally have more curved arteries without symptoms.

• Other medical conditions: Certain diseases affecting blood vessels or connective tissue can contribute.

  
  

In people with HEDS, the weakened connective tissue means the carotid arteries are less supported and more likely to develop tortuosity. This can sometimes lead to complications like reduced blood flow or increased risk of artery dissection.

Carotid artery tortuosity is relatively common in the general population, especially among older adults. Studies suggest that up to 25% of people may have some degree of tortuosity without symptoms. However, the prevalence is higher in people with connective tissue disorders like HEDS.

Research shows that individuals with HEDS have a significantly increased risk of vascular abnormalities, including tortuosity of the carotid arteries. While exact numbers vary, some studies report that more than half of patients with HEDS show signs of arterial tortuosity on imaging tests.

Many people with carotid artery tortuosity do not experience symptoms. When symptoms occur, they may include:

• Dizziness or lightheadedness

• Headaches

• Neck pain

• Transient ischemic attacks (mini-strokes)

• Stroke in severe cases

  
  

The risk of serious complications depends on the degree of tortuosity and whether the artery walls are weakened, as in HEDS. In some cases, tortuosity can cause turbulent blood flow, increasing the risk of blood clots or artery dissection.

Doctors often discover carotid artery tortuosity during imaging tests such as:

• Ultrasound Doppler studies

• CT angiography

• Magnetic resonance angiography (MRA)

  
  

For patients with HEDS, regular vascular screening may be recommended to monitor artery health. Early detection helps manage risks and prevent complications.

There is no specific cure for carotid artery tortuosity, but management focuses on reducing risks and symptoms:

• Blood pressure control: Keeping blood pressure in a healthy range reduces stress on arteries.

• Lifestyle changes: Avoiding smoking, maintaining a healthy weight, and regular exercise support vascular health.

• Medications: In some cases, doctors may prescribe blood thinners or other drugs to reduce stroke risk.

• Monitoring: Regular imaging helps track changes in artery shape and function.

• Surgery: Rarely, severe tortuosity causing symptoms may require surgical correction.

  
  

For people with HEDS, working closely with a healthcare team familiar with connective tissue disorders is important. They can tailor treatment plans to individual needs.

If you have HEDS or suspect carotid artery tortuosity, consider these points:

• Report any new symptoms like dizziness or headaches to your doctor.

• Ask about vascular screening if you have HEDS.

• Manage blood pressure and avoid activities that strain your neck or arteries.

• Understand that tortuosity is often manageable with proper care.