OBJECTIVE The aim of this study was to provide information on the diagnosis and treatment of kinking -- bends in the extracranial internal carotid artery (KICA), a rate but major and treatable cause of cerebral ischemia. METHODS A retrospective review of the seven-year experience in Split Hospital. ESSENTIAL DATA: The role of the surgical correction of carotid artery kinking has not yet been precisely defined. METHODS Of the 86 carotid revascularization operations performed in 76 patients from 1988 to 1994, 21 (29%) patients underwent surgery owing to symptomatic kinking of the internal carotid artery. This group included 8 females and 13 males with a mean age of 57.3+/-5.5 years (range 44-70). Symptoms included cerebrovascular insults in 43%, hemispheric transient ischemic attacks in 33%, reversible ischemic neurological deficit in 24% of patients. The diagnosis was made using two-dimensional ultrasound scan and Doppler, computerised tomography and angiographic evaluation. Two methods were used: the elimination of kinking and graft of the internal artery onto the common carotid artery with excision of the kinked section of the artery and end-to-end anastomosis. Dense fibrous tissues around the kinked artery were removed and the artery was freed along its entire course. The anomalous relationship between the internal carotid artery, occipital artery and hypoglossal nerve was corrected. RESULTS After surgery seventeen patients fully recovered without neurological complications. One patient died, one patient suffered permanent neurological deficit, two suffered from transient ischemic attacks. CONCLUSIONS Anatomic reconstruction together with the correction and elimination of the affected segments of the carotid artery may prevent progressive cerebrovascular symptoms and is associated with a low morbidity and mortality rate.