Surgical Repair of Complex Distal Internal Common Carotid Artery Aneurysm

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<h3>Introduction</h3> Carotid artery aneurysms are a rare occurrence with potentially severe complications including neurological symptoms from embolization and rarely rupture. They comprise between 0.4%-4% of all peripheral aneurysms and are between 0.1%-3.7% of carotid procedures at major centers. The following is a discussion of one such procedure for a complex right common carotid with distal extension into the internal carotid artery. <h3>Methods/Results</h3> Patient was a 64-year-old male with incidental finding of right common and internal carotid artery aneurysm and occlusion of the contralateral side seen on Computer Tomography scan. Based on the patient's age and anatomy the decision was made to proceed with an open repair of the aneurysm. Due to the distal location of the internal catrotid aneurysm adequate exposure was achieved using general nasotracheal anesthesia and ligation of the occipital artery. The oral maxillofacial surgeon was on standby for possible mandible dissection; however, this was unnecessary. The reconstruction was performed using reversed femoral vein. An Argyle shunt was used to bypass the aneurysm to maintain blood flow through the internal carotid artery. An ulcerated region of the aneurysm was resected and the distal and proximal anastomosises were created. The external carotid artery was then ligated and a carotid duplex ultrasound performed intraoperatively revealed satisfactory endpoints and no evidence of significant stenosis. Upon awakening the patient, a brief neurological exam showed no deficits.Figure 1CTA of AneurysmFigure 1Figure 23D Reconstruction of CTFigure 2Figure 3Intraoperative Image Prior to BypassFigure 3Figure 4Intraoperative Image After BypassFigure 4Figure 5Follow Up Ultrasound at 4 WeeksFigure 5 Intraoperative cerebral oximetry and neuromonitoring were used throughout the procedure. Immediately post-operation the patient had transient hypoparesis which had resolved at 4 week follow up. <h3>Conclusion</h3> Carotid artery aneurysms, although rare, have a mortality rate up to 70% and a stroke rate greater than 50%; therefore, surgical intervention is the treatment of choice, with open intervention being the most common. This case demonstrates that even with an occluded contralateral carotid artery and a complex aneurysm with distal extension, carotid bypass can be done safely using stents and adequate neuromonitoring.