Extracranial Internal Carotid Artery Aneurysms: Report of a Ruptured Case and Review of the Literature

Abstract

Aneurysms of the extracranial carotid arteries (ECAA) are extremely rare. Schechter et al. [1] documented 835 cases in the literature up to 1977. One hundred and sixteen cases of ECAA have been documented in the Chinese literature since 1981, suggesting a higher prevalence of carotid aneurysmal disease in China than in the West. Four percent of all peripheral artery aneurysms are reported to be ECAA [2]. Those arising from the internal carotid artery (EICAA) are even more rare. Two recent reviews [3, 4] reported 24 and 25 cases of EICAA during 21 and 17 years, respectively, the majority of them is treated surgically. Our literature review revealed only a few true EICAA managed endovascularly, but none of them with a covered stent. We describe a rare such case of ruptured atherosclerotic EICAA which was treated percutaneously.

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

“…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.…”

“…[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. [5] Accordingly, our case series showed intra-aneurysmal thrombus in 66% (two of three) of the cases.…”

“…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.…”

Embolic Stroke Complicating Cervical Aneurysm

“…Other causes of cervical aneurysms are very rare compared with dissection. Atherosclerotic aneurysms were reported to be fusiform and located at the level of the carotid bifurcation [8,9] , characteristics that were missing here. Mycotic aneurysms are extremely rare [10] , and were clinically excluded in our study.…”

Extracranial carotid arteries aneurysms in children

“…Aneurysms of the extracranial portion of the carotid artery are extremely rare, accounting only for 0.5% to 1.9% of all the carotid operations and 4% of all peripheral aneurysms in adults [1,2]. In infancy and childhood particularly, very few cases have been reported.…”