Surgical and medical management of extracranial carotid artery aneurysms

Fankhauser, Grant T.; Stone, William M.; Fowl, Richard J.; O’Donnell, Mark E.; Bower, Thomas C.; Meyer, Fredric B.; Money, Samuel R.

doi:10.1016/j.jvs.2014.07.092

Cited by 110 publications

(85 citation statements)

References 20 publications

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“…In terms of ECAA type, some researchers found that long-term outcomes after the endovascular procedures were better in the treatment of pseudoaneurysms than true aneurysms. [20] The main reason for this finding is that the causes of the pseudoaneurysms were believed to be self-limited and not likely to reoccur after endovascular therapy, whereas the causes of true aneurysms, such as atherosclerosis, are ongoing and could lead to further aneurysmal degeneration. Another reason is that true aneurysms often have a significant amount of thrombus inside the sac and frequently cause cerebral embolic events during the endovascular procedure compared to pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

Endovascular stenting for extracranial carotid artery aneurysms

Zeng

et al. 2016

Medicine

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The aim of this study was to investigate the safety and effectiveness of endovascular stenting for extracranial carotid artery aneurysms (ECAAs) and evaluate the mid-term outcomes.Twelve consecutive symptomatic patients (mean age 43.8 ± 14.9 years; 8 men) with ECAAs who were treated with endovascular stenting between 1997 and 2015 were retrospectively analyzed. Clinical follow-up data including symptoms and neurological events were obtained from outpatient records. Imaging follow-up with duplex ultrasound and/or computed tomographic angiography (CTA) was performed to examine the aneurysm obliteration and patency of the stents at 3, 6, 12 months and yearly thereafter.A total of 5 true aneurysms and 7 pseudoaneurysms were included in our series. Neurological symptoms (n = 5, 41.7%) and a pulsatile neck mass (n = 5, 41.7%) were the most common presenting symptoms. Endovascular stenting procedures were technically successful in all cases; 3 patients received bare stents, and 9 patients received covered stents. No perioperative neurologic or cardiopulmonary complications occurred. Over a period of follow-ups (mean 21.8 ± 25.1 months), all patients were alive and free from neurological or other adverse events. All aneurysms were completely excluded except for 1 patient who was exposed to a residual medium leaking into the aneurysm sac. No reintervention was performed in this specific patient because aneurysm growth or significant clinical symptoms did not occur. Recurrent restenosis assessed by CTA imaging at 12 months occurred in 1 (8.3%) patient in our series. Target lesion revascularization for this hemodynamic restenosis was treated with placement of an additional stent.In our series, endovascular stenting for ECAAs was found to be safe, effective, and proved to have promising mid-term results. Although long-term results need to be further explored, advantages including less procedure-related complications and a shorter recovery time make endovascular stenting an attractive option for ECAAs, especially for the patients who are unfit for traditional open surgery.

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Section: Discussionmentioning

confidence: 99%

Endovascular stenting for extracranial carotid artery aneurysms

Zeng

et al. 2016

Medicine

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“…Other etiologies have been reported, including traumatic, iatrogenic (post-carotid endarterectomy), infections, and systemic diseases, such as fibromuscular dysplasia or collagen diseases, including Marfan's syndrome. [138] The most common presenting symptom of ECAA is transient ischemic attack (TIA) caused by emboli. [12458] This is supported by the fact that thrombosis in the aneurysmal sac was found in up to 18% of ECAAs.…”

Section: Discussionmentioning

confidence: 99%

“…Other presenting symptoms can include aneurysm rupture, paralysis of the cranial nerves due to compression by the giant aneurysm, and enlarging pulsatile or nonpulsatile neck mass. [138] Surgical treatment is generally accepted as a primary method of treating ECAA based on the high mortality risk in conservatively treated cases. [2] Total aneurysmectomy with direct end-to-end anastomosis or grafting, partial aneurysmectomy with patch closure, aneurysmorraphy, ligation of the ICA, or EC–IC bypass have been attempted as surgical management in previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…[3458910] However, even the largest available series in the literature on ECAA management, defining treatment indication for both surgical and endovascular intervention, is not possible because of the low quality of studies and confounding by indication. [10] In cases of high position of the aneurysm and hostile neck due to previous surgery and/or radiation, endovascular stenting seems to be indicated rather than open surgery, which is related to higher occurrence of cranial nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…[1310] Progressive enlargement of a cervical internal carotid artery (ICA)/common carotid artery (CCA) aneurysm can result in devastating sequela with possible rupture, lower cranial nerve injury, and intracranial embolic spray from intra-aneurysmal thrombi. However, a standard treatment strategy has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

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Surgical strategy to minimize ischemia during trapping/resection of giant extracranial carotid artery aneurysm stratified by collateral evaluation

Hongo¹,

Inoue²,

Tamura³

et al. 2017

Surg Neurol Int

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Background:Extracranial carotid artery aneurysm (ECAA) is a rare clinical entity, and no standard treatment strategy has been established for this condition.Methods:Data from three patients who underwent surgical treatment of enlarging giant ECAAs were retrospectively reviewed. Based on the collateral status, as evaluated by preoperative digital subtraction angiography (DSA), surgical strategy was stratified into (1) high flow bypass followed by cervical ICA (internal carotid artery) ligation, when the collateral status was judged as poor/fair or (2) direct cervical repair with patch application after aneurysmal wall resection when the collateral status was judged as robust. Postoperative results were evaluated by magnetic resonance imaging (MRI).Results:Postoperative follow-up (day 0 to 1, as well as midterm at approximately 6 months) confirmed completely trapped aneurysm with successful robust bypass and robust anterograde flow of the reconstructed cervical carotid artery on magnetic resonance angiography with no additional ischemic lesions on diffusion weighted imaging and T2-weighted imaging when compared with preoperative imaging in all three patients. Postoperatively, there was no stroke event during the midterm follow-up at 6 months.Conclusions:Clinical results of ECAAs treated by a surgical strategy stratified based on collateral status, as evaluated by preoperative DSA, were favorable, without postoperative ischemic event, and with satisfactory mid-term MRI results.

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Surgical management of extracranial internal carotid artery aneurysm—Case report and literature review

Jaha,

Ademi,

Rudari

et al. 2023

Clinical Case Reports

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Key Clinical MessageExtracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck.AbstractExtracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70‐year‐old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long‐standing coronary artery disease. Imaging investigation in terms of ultrasound and CT‐scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end‐to‐end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.

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Surgical and medical management of extracranial carotid artery aneurysms

Cited by 110 publications

References 20 publications

Endovascular stenting for extracranial carotid artery aneurysms

Endovascular stenting for extracranial carotid artery aneurysms

Surgical strategy to minimize ischemia during trapping/resection of giant extracranial carotid artery aneurysm stratified by collateral evaluation

Surgical management of extracranial internal carotid artery aneurysm—Case report and literature review

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