Mycotic Extracranial Carotid Artery Aneurysms: A Systematic Review

Abstract

Mycotic extracranial carotid artery aneurysms are rare and their management varies owing to a lack of evidence assessing the outcomes. We undertook a systematic literature review to assess the appropriate treatment of mycotic extracranial carotid artery aneurysms. Following the PRIMSA (preferred reporting items for systematic reviews and meta-analyses) guidelines, the Medline and Embase databases were searched for all cases of extracranial carotid artery aneurysms between January 1970 and March 2021. The search terms used were “infect,” “abscess,” “mycotic,” “carotid,” “aneurysm,” and “pseudoaneurysm.” “Aneurysm, infected” and “carotid artery diseases” subject headings were used. Titles and abstracts were screened before the full-text reports were reviewed. We identified 193 such aneurysm cases from 154 sources. The patients were predominantly male (71.4%), with an age range of 6 months to 89 years. The most common presentations were a neck mass and fever but also included hemorrhage, respiratory distress, and neurologic symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.4%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (21.1%). Most appeared to have become infected by direct local spread. The treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41. In four cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases, antibiotic treatment alone was used. In the open surgery treated group, the complication rate was 20.8% compared with 13.2% in the endovascular group. Mortality was 5.6%. Direct local spread of a staphylococcus infection was the most common cause. Endovascular management was associated with fewer complications than open surgical management and is recommended.