Surgical management of extracranial carotid artery aneurysms

Abstract

Abstract. Background: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. Patients and methods: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33 - 84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1 %), previous carotid endarterectomy with Dacron patch (n = 4; 12.5 %), iatrogenic injury (n = 2; 6.3 %) and infection (n = 1; 3.1 %). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. Results: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9 %). There was one perioperative death due to major stroke (3.1 %). Two cases of minor stroke occurred in the 30-day observation period (6.3 %). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4 %). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9 %), long-term clinical outcomes were free from ipsilateral neurological symptoms. Conclusions: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

Endovascular treatment of extracranial carotid artery aneurysms using self-expandable covered stent grafts: A single center retrospective study

“…Patients with ECAA are at high risk of ischemic stroke due to distal embolic occlusion secondary to dislodgement of thrombus in the aneurysm sac. 16 In the present case series, 37.5% patients (3/8) suffered from cerebral ischemic symptoms. Moreover, internal CCF occurred in one patient after endovascular of ECAA in the present study, which indicated that cerebral hemodynamic changes also contributed to cerebrovascular accident.…”

PAMAM Dendrimers Attached to Collagen via a Malondialdehyde Linker

“…Thus, we have concluded that MDA can serve as a linker to bind PAMAM based macromolecules onto a collagen scaffold covalently. Collagen based fibrin sealants have been tested for use as topical hemostatic agents and currently such patches are used by surgeons in variety of medical conditions …”

Multimodality Imaging Findings and Surgical Treatment of a Patient with Symptomatic, Bilateral, Gigantic Extracranial Carotid Artery Aneurysms Case Report and Review of the Literature

“…15 aneurysms -none bilateral-in a 20-years period, Rosset, et al [8]. 25 aneurysms among 1936 carotid reconstructions -none bilateral-in a 18-years period, and more recently, Jan Paweł Skora, et al [9]. 32 aneurysms-1 of them bilateral (6,25%) in a 26-years period).…”