Management of Extracranial Carotid Artery Aneurysms: A 6-Year Case Series

Abstract

Background We discuss the presentation and management of extracranial carotid artery aneurysms (ECAAs) and to develop a new type of classification. Material/Methods A retrospective review of 35 ECAAs patients who were admitted in our institution from January 2010 to June 2016 was conducted. The mean follow-up period was 25.58±22.13 months. Results During the study period, 35 aneurysms were diagnosed and treated (mean age, 50.8±15.6 years; 15 men). There were 28 true aneurysms, 5 false aneurysms, and 2 dissecting aneurysms. A total of 16 patients with true aneurysms underwent open surgical treatment (group 1), whereas 15 received endovascular management, including all false and dissecting aneurysms (group 2). The remaining 4 true aneurysms were treated with hybrid operation (group 3). The patency rates of groups 1, 2, and 3 were 100%, 93.3%, and 100%, respectively. According to the Peking Union Medical College Hospital (PUMCH) Classification, all 24 cases of type Ia aneurysms were treated by either open surgery and/or endovascular treatment, whereas all 3 type Ib cases were treated solely by open surgery. All 5 type IIa patients were treated by endovascular treatment, with the exception of 1 failure that was transferred to hybrid operation. All 3 type IIb patients were treated by hybrid operation. Conclusions Open surgery was more frequently feasible in true aneurysms, and endovascular surgery was the first choice for false and dissecting aneurysms. Hybrid operation was available for complicated cases. The PUMCH classification may be helpful for selection of management strategies for ECAAs.

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

“…The optimal treatment strategy is still on debate mainly because of small numbers of experiences and lack of guidelines. 1–3,5,8–12 Conservative management comprising of anticoagulation or antiplatelet medication might be justified in lower risks of cerebral stroke in asymptomatic patients, but seems ineffective in relieving symptom burden, and the risks of thrombus formation and cerebrovascular accidents still remain. 2,9,13 Surgical exclusion of aneurysm with restoration of blood flow has been regarded as the primary strategy in symptomatic or growing ECAAs.…”

“…2,9,13 Surgical exclusion of aneurysm with restoration of blood flow has been regarded as the primary strategy in symptomatic or growing ECAAs. 3,8,12,13 However, the surgical approach is associated with a high risk of cranial nerve injury especially in the lesion close to the base of skull and longer hospital stays. 8,10 With advances in catheter technology and increasing experiences, endovascular treatment has emerged as a minimally invasive alternative to open surgery, particularly in highly positioned aneurysms, hostile neck, or surgically high-risk patients.…”

Surgical Management of a Type II Extracranial Internal Carotid Aneurysm near to the Skull Base

“…The incidence of true aneurysms involving the extracranial ICA accounts for less than 1% of cases [ 2 , 4 ], and clinical findings may vary according to their location, size, and etiology. The most common symptoms are pulsatile mass, local pain, and dysphagia, but more important manifestations that heighten suspicion of this pathology are neurological symptoms.…”

Giant saccular aneurysm of the internal carotid artery with adhesion to the vagus nerve: A Case Report

“…The endovascular approach of the ICA aneurysms has become more popular and was shown to be an effective treatment. Both covered and bare-metal stents have been reported [ 11 ]. Arterial embolism, recurrent stenosis, or occlusion are possible post-interventional complications.…”