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.

Overlapped Stenting for Treatment of an Extracranial Carotid Artery Aneurysm

“…1,3,4) Other modes of presentation include a pulsatile mass in the neck, as in the present patient, as well as lower cranial nerve palsies and Horner's syndrome. When symptoms of compression due to an aneurysm are severe, airway obstruction may develop, but aneurysm rupture is relatively uncommon.…”

“…1) Open surgery is a common treatment and reported to be effective. 2,3) However, with recent advances in medical devices, endovascular treatment of ECAA is increasing, with covered stents being used in a relatively large number of cases.…”

Technical Options for the Surgical Management of Extracranial Carotid Artery Aneurysms

“…True aneurysms are most commonly due to atherosclerosis, accounting for 34% to 70% of all published cases. 7,26) Other reported causes of true aneurysms are arteritis, infection, fibromuscular dysplasia, tuberculosis, human immunodeficiency virus, collagen-vascular disease, irradiation, Behcet's disease, and cystic medial necrosis. 2,7,8,14,18,19) There are also multiple causes of false aneurysms.…”

“…1,7,17,23,24,26) The rationale of treatment for ECA aneurysms has been based on the high mortality risk in their natural history. 9,23,26) Carotid artery ligation was the first successful treatment of ECA aneurysm (performed by Sir Astley Cooper in 1808). Patients who underwent proximal carotid artery ligation of an ECA aneurysm had a mortality rate of 28%.…”

“…3,6,15,16,23,26) Early reports showed 60% to 70% mortality rate with conservative therapies, and À50% stroke rate in the natural history of ECA aneurysms. 6,26) However, benign long-term outcome associated with conservative treatment including mainly aspirin administration was recently reported. 1) Endovascular techniques have recently evolved significantly, but the results of large series and long follow-up periods after such treatment have not been obtained yet.…”