Εndovascular Repair of Extracranial Carotid Artery Aneurysms: A Systematic Review

Abstract

Objective: Both true and false extracranial carotid artery aneurysms (ECAA) are a potential source of morbidity and mortality. While ECAA have historically been treated surgically, endovascular reconstruction with stenting is an emerging treatment option. The aim of our study was to report clinical/radiologic outcomes following endovascular repair of ECAAs. Methods: A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Results: A total of 68 case reports and case series, comprising 162 patients, were included. Most patients presented with at least one symptom or sign related to the ECAA (89.5%; N = 145/162). In 42.6% (N = 69/162) and 46.3% (N = 75/162) of the cases polytetrafluoroethylene covered and uncovered stents were deployed respectively. Immediate post-procedural imaging demonstrated complete aneurysm exclusion in 86.4% (N = 140/162) of the cases and minimal filling of the aneurysm sack in 10.5% (N = 17/162) of all cases. Perioperative adverse event rates were 3.1% for stroke, 1.2% for transient ischemic attack (TIA) and 4.3% for mortality. During a mean follow-up of 21.8months, there were additionally observed one stroke, two TIAs and three deaths. Overall 88.6 % of the patients (N = 117/132) remained asymptomatic, partially recovered or at least did not suffer from new neurologic deficits during follow up, with no signs of stenosis or occlusion of the carotid artery. Conclusions: Endovascular stenting for the treatment of ECAAs is feasible with acceptable short- and long-term clinical and radiologic outcomes. Prospective real-world studies are needed to further validate the safety and the long-term patency of endovascular repair.

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

“…Surgical treatment requires an approach meticulously based on the etiology, size, and location of the aneurysm, associated factors, and existing comorbidities [ 7 , 8 ]. Given the rapid development of endovascular technology, it has become a preferred option among endovascular surgeons as a vital method for treating CAA [ 9 , 10 ]. The 30-day outcomes of endovascular procedures are reported to be better than those of open surgical procedures [ 10 ].…”

“…Given the rapid development of endovascular technology, it has become a preferred option among endovascular surgeons as a vital method for treating CAA [ 9 , 10 ]. The 30-day outcomes of endovascular procedures are reported to be better than those of open surgical procedures [ 10 ]. The durability and thrombosis rates, which were 93.2% with stent grafts and 97% with bare metal stents, along with sac thrombosis rates of 93% and 70.6%, respectively, were comparatively lower than those of conventional repair.…”

Posttraumatic pseudoaneurysm of extracranial internal carotid artery presenting as massive oropharyngeal bleed with shock and hemiparesis in a 12-year-old boy: A case report

“…Endovascular repair is more often chosen initially for patients with pseudoaneurysms due to traumatic mechanisms or as a result of carotid dissection. [ 10 11 ] Endovascular stenting for the treatment of Extracranial carotid artery pseudoaneurysm is possible with acceptable acute and long-term clinical and radiologic outcomes. [ 10 11 ] Endovascular means of treatment for pediatric neck aneurysms are relatively simple and safe.…”

“…[ 10 11 ] Endovascular stenting for the treatment of Extracranial carotid artery pseudoaneurysm is possible with acceptable acute and long-term clinical and radiologic outcomes. [ 10 11 ] Endovascular means of treatment for pediatric neck aneurysms are relatively simple and safe. [ 6 ] Endovascular stenting is technically feasible with high procedure success and a relatively low complication rate in patients with EICA.…”

Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma

“…In general, for extracranial ICA blunt injury, the survivors who accept EVT have a good prognosis due to the high success rate [92,93]. The systematic review of Pavlos et al (2020) included twenty-four studies comprising 191 patients (204 lesions) and showed that EVT for extracranial ICA blunt injury was associated with excellent outcomes and efficiently prevented recurrent stroke and TIA and demonstrated excellent recanalization and pseudoaneurysm occlusion rates with very low retreatment rates [94].…”