Extracranial Carotid Artery Aneurysms

Abstract

Extracranial carotid artery (ECCAs) aneurysms are rare, accounting for up to less than 1% of all arterial aneurysms. The aneurysms are broadly classified as true aneurysms mostly due to atherosclerotic disease or false aneurysms due to secondary causes including dissection, infection, or local trauma. The segment of the carotid artery around the bifurcation is most commonly affected. Most symptomatic patients present with strokes or local mass effect. Despite the rarity, treatment may be indicated in this cohort because of the higher risk of embolic or occlusive strokes. Surgical resection of the aneurysm and bypass using a graft has been the traditional treatment methods. Other surgical treatment options include carotid ligation, aneurysmorrhaphy, or high flow bypass procedures. Recently, endovascular treatment has evolved as a minimally invasive approach with a comparable outcomes to surgery. Use of covered stents has been the most commonly described endovascular option; however, recent successful reports of using layered bare metal stents and flow diverters are encouraging. A definite guideline for treatment is lacking owing to the rarity of the lesion and scarcity of research involved in this disease. However, available evidence suggests that surgery and endovascular management may be better suited for true and false aneurysms, respectively.