Extracranial Internal Carotid Artery Aneurysm in Pregnancy

Abstract

Isolated extracranial internal carotid artery aneurysms (EICAAs) are rare, accounting for only about .4–4% of all peripheral artery aneurysms. We present a case of an EICAA in a young pregnant patient. To our knowledge, this is the first case being reported of a true EICAA during pregnancy in a multiparous woman. A 25-year-old pregnant patient presented with a pulsatile left neck swelling. Radiological investigations and subsequent surgery during the first trimester confirmed a true saccular left ICA with a maximum diameter of 3.5 cm. She was treated with aneurysm excision and primary anastomosis. She did not have any underlying diseases predisposing to an EICAA. She has been well for 3 years post procedure. It has been postulated that pregnancy could lead to aneurysm development through multiple mechanisms, including hemodynamic, hormonal, and other physiologic changes of pregnancy. Aggressive treatment with surgical intervention is advocated because of the risk of cerebral ischemic complications associated with non-operative treatment, and because satisfactory long-term outcomes can be achieved from surgery.

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

“…While the specific causes of ECA aneurysms are yet to be fully understood, atherosclerosis is the most frequently acknowledged cause among elderly patients, alongside other factors such as trauma, fibromuscular dysplasia, previous surgery, congenital and acquired malformation, infection, and radiation exposure 1–6 . There are articles suggesting that occurrence of the ECCA may be linked to body mass index 7 On the contrary, a false aneurysm can be caused by medical intervention, such as carotid endarterectomy, or as a result of trauma or dissection or spontaneously, including in children and pregnant women 8,9 . It has been observed that up to 13% of patients with EICAA exhibit bilateral EICAAs.…”

“… 1 , 2 , 3 , 4 , 5 , 6 There are articles suggesting that occurrence of the ECCA may be linked to body mass index 7 On the contrary, a false aneurysm can be caused by medical intervention, such as carotid endarterectomy, or as a result of trauma or dissection or spontaneously, including in children and pregnant women. 8 , 9 It has been observed that up to 13% of patients with EICAA exhibit bilateral EICAAs. Additionally, multiple synchronous aneurysms, specifically intracranial ones, have been documented in approximately 15%–20% of patients diagnosed with EICAA.…”