Atherosclerotic extracranial carotid artery aneurysms

Abstract

Twenty-four atherosclerotic extracranial carotid artery aneurysms were encountered in 21 patients during a 25-year period. These represented 46% of all extracranial carotid artery aneurysms diagnosed at the University of Michigan during this period. Neurologic symptoms including amaurosis fugax, transient ischemic attacks, and stroke were present in 50% of the patients. An asymptomatic pulsatile neck mass occurred in 33%. Surgical therapy was undertaken for 18 aneurysms, and nonoperative treatment was pursued in the remaining six aneurysms. Operative therapy included 14 aneurysmectomies and four aneurysmorraphies. There were no surgical deaths. Transient perioperative neurologic deficits affected three of these patients (17%), and one individual (5%) experienced a permanent deficit. Transient cranial nerve deficits occurred in three patients (17%), and a permanent deficit was noted in one patient (5%). During a 7.6-year follow-up period no late strokes occurred among patients who were operated on. Nonoperative therapy was associated with three ipsilateral strokes during a mean follow-up period of 6.3 years. Atherosclerotic extracranial carotid artery aneurysms were associated with an exceptionally high stroke rate (50%) if treated nonoperatively. Prevention of late stroke justifies surgery, although perioperative neurologic deficits may accompany this therapy more often than with nonatherosclerotic carotid artery aneurysms.

Endovascular stenting for extracranial carotid artery aneurysms

“…[14] In the past 5 decades, the surgical technique of aneurysm resection combined with reconstruction of the carotid arterial system has been regarded as the golden standard. [6,9,15,16] However, postoperative complications are more frequent in surgical procedures because of their greater invasiveness. Cranial nerve injuries, which is the most common complications, range from 11% to 26%.…”

“…[8] Conservative medical treatments including anticoagulation or antiplatelet drugs have been reported to lower the risk of ischemic events but are not effective at resolving lesions; thus, a long-term risk of embolization is possible. [9,10] Since Dimtza [11] performed the first successful carotid aneurysm excision in 1952, aneurysm resection with or without carotid artery reconstruction is regarded as the first-line option for surgical treatment. Currently, with the increasing availability of endovascular surgery, endovascular intervention, as an alternative, outshines open surgery in highly located aneurysms or hostile neck conditions caused by interventions such as radiation therapy and previous neck surgery.…”

Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

“…Neurologic disorders are most common and typically include focal symptoms such as strokes, transient ischaemic attacks (TIA), transient amaurosis, and anopsia. Less commonly described are Horner's syndrome, inarticulate speech, facial numbness, and retinal infarction [2, 3, 5, 6]. …”

“…Operation can be performed in general or regional anaesthesia [4, 15]. Conservative treatment carries a high risk of thromboembolic events and aneurysm rupture and thus is applicable in selected groups of patients only [2, 6]. …”

Massive carotid artery aneurysm presenting as an oropharyngeal swelling in a young woman

“…Carotid artery aneurysms in the oropharynx or neck may be mistaken for an inflammatory or neoplastic lesion of a tonsil, peritonsilar abscess or neck tumour 9 10. Carotid artery aneurysms are associated with catastrophic complications if untreated.…”