External Carotid Artery Aneurysm Research Articles

Embolization of Branches External Carotid Artery Aneurysm Prior Third Molar Extraction: A Case Report

Embolization of Branches External Carotid Artery Aneurysm Prior Third Molar Extraction: A Case Report

Intra-aneurysmal embolization of cellulose porous beads to regenerate vessel wall: an experimental study.

Although the treatment of intracranial cerebral aneurysms with detachable coils is now widely accepted, the problem of coil compaction and recanalization remains unsolved. If the vessel wall can be regenerated at the neck orifice of an aneurysm, thereby reducing the blood flow into the aneurysm, the recurrence rate of the aneurysm would decrease. Accordingly, we aimed to insert cellulose porous beads (CPBs) into rat models of external carotid artery (ECA) aneurysm and study their efficacy in promoting vessel wall regeneration. Using a rat aneurysm model, we examined the tissue response to CPBs that were inserted into the ligated ECA sac of rats. The sacs were removed on days 14, 42, 84, and 180 after insertion and subjected to conventional and immunohistochemical examination. We evaluated the tissue response in the ECA sacs and observed the vessel wall regeneration progress. At the neck orifice of the aneurysm in which the CPB was inserted, a layer of regenerating α-smooth muscle actin-positive spindle cells was observed on day 14. The regenerative cell layer gradually thickened until day 42 and, thereafter, the thickness remained unchanged until day 180. A monolayer of factor VIII-positive cells also appeared at the neck orifice on day 14 and covered the entire orifice until day 180. The CPBs were stably localized in the sac without degradation or signs of inflammation. CPBs may be promising as embolic materials that can induce stable vessel wall regeneration at the neck orifice of an aneurysm without surrounding inflammatory reactions.

False aneurysm of external carotid artery diagnosed after thyroidectomy

The patient 58-year-old with nodular goiter grade 2 was hospitalized to the surgical clinic. Thyroidectomy was performed. Postoperative period was complicated by hiccups and pulsation in the right half of the neck. According to angiography and CT data, there were a hematoma within thyroid bed and arteriovenous fistula between superior thyroid artery and right facial vein. Surgical repair of the fistula and false aneurysm drainage were carried out. This case report demonstrates a rare complication of thyroidectomy - arteriovenous fistula between superior thyroid artery and facial vein followed by pulsatile false aneurysm.

Spontaneous Aneurysm of External Carotid Artery: Management and Complications

AbstractExtracranial carotid artery aneurysm is a rare vascular disease in the neck with variable presentation. Aneurysms are associated with significant mortality and morbidity and are associated with fatal complication secondary to spontaneous rupture or tracheal compression or laryngeal edema and distal embolization. A 43-year-old male patient presented with large aneurysm arising from proximal common carotid artery (CCA) causing tracheal obstruction leading to life-threatening respiratory symptoms. The endovascular interventional management is an emerging alternative for surgical option and providing promising results with almost similar safety and efficacy. Endovascular management of an extracranial carotid artery aneurysm using stent graft is minimally invasive and effective.

Aspirin and Clopidogrel Inhibit Aneurysm Healing after HydroCoil Implantation in External Carotid Artery Aneurysm Model

To understand whether the use of antiplatelet agents leads to less intra-aneurismal tissue formation following coil implantation in a rat end-pouch external carotid artery (ECA) aneurysm model. End-pouch ECA aneurysms were created in adult rats and were then embedded with either platinum or HydroCoils. Rats were treated either with aspirin, clopidogrel, aspirin + clopidogrel, or saline for 2 weeks after coil implantation. At 2 weeks after coil implantation, rats were sacrificed and the aneurysm pouch was removed for histological and immunohistochemical analysis. A blinded single observer calculated the percentage of the organized area and the residual length of elastic lamina within the aneurysm. Student's t-test was used to compare data from image analysis between the different groups. Within the platinum group, the organized tissue area was not affected by antiplatelet administration (aspirin versus saline, P = .83; clopidogrel versus saline, P = .46; aspirin + clopidogrel versus saline, P = .54). For the HydroCoil group, the organized tissue area was significantly reduced (aspirin versus saline, P = .02; clopidogrel versus saline, P = .04; aspirin + clopidogrel versus saline, P = .02) in rats treated with antiplatelet agents; however, no difference (aspirin versus clopidogrel, P = .8; aspirin versus aspirin + clopidogrel, P = .3; clopidogrel versus aspirin + clopidogrel, P = .5) was found among type or combination of antiplatelets administered. HydroCoil-treated aneurysms had a similar number of macrophages compared to the platinum group (P = .3819); however, the HydroCoil group had significant suppression of macrophages in the groups treated with combined antiplatelets (P = .02). Following HydroCoil implantation, the area of organized tissue is diminished significantly in a rat end-pouch ECA aneurysm model treated with antiplatelets.

A case of external carotid artery aneurysm caused by CO2 laser submucosal dissection for a mesopharyngeal leukoplaqia lesion in a patient treated with irradiation for nasopharyngeal carcinoma

A case of external carotid artery aneurysm caused by CO₂ laser submucosal dissection for a mesopharyngeal leukoplaqia lesion in a patient treated with irradiation for nasopharyngeal carcinoma

Intraparotid Arterial Aneurysm Treated with Embolization Followed by Surgical Resection

We describe the case of a 41-year-old woman who presented to a local facial plastic surgeon for evaluation of a cosmetic defect of the cheek of 1 month's duration. When imaging revealed the presence of a vascular mass, the patient was referred to us. Further imaging identified the mass as an intraparotid external carotid artery aneurysm. The decision was then made to treat the patient with embolization of the lesion followed by surgical resection the next day. During the resection, the lateral-most aspect of the aneurysm was found to be adherent to and splaying the facial nerve. The embolized mass and the surrounding fascial layer were removed, and the branches of the facial nerve were retracted superiorly and inferiorly. Dissection proceeded around the aneurysm in this plane. Blood loss during the procedure was minimal. On postoperative day 1, the patient exhibited minimal lower facial asymmetry. In this case, performing embolization prior to surgical resection appeared to be a prudent and efficacious strategy. The preoperative embolization greatly reduced the risk of damage to the facial nerve.

頚部動脈瘤に対して血管内治療を行った４例

Cervical carotid artery aneurysms are rare and sometimes induce not only hemorrhage but also ischemic stroke. Various surgical treatments are reported to prevent hemorrhage and stroke. We report the result of endovascular therapies for 4 patients who had large or giant cervical carotid artery aneurysms. Endovascular therapies were performed for 4 patients and 5 aneurysms, from January 2003 to October 2007. One patient had external carotid artery aneurysm and the other 3 patients had common or internal carotid artery aneurysms. One patient had 2 cervical carotid artery aneurysms. Case 1 had an external carotid artery aneurysm and underwent parent artery occlusion (PAO); the aneurysm was occluded without any event. Case 2 had an internal carotid artery (ICA) aneurysm and also underwent PAO, but the internal carotid artery showed recanalization 2 days later on magnetic resonance image. Therefore, we added endovascular coil embolization and occluded the aneurysm completely. Case 3 had 1 aneurysm and Case 4 had 2 aneurysms on the common carotid artery (CCA) to ICA. Bare metal stents were deployed, followed by endovascular embolization for 2 aneurysms. One aneurysm in Case 4 on which only stenting was performed completely occluded 1 year after procedure. On 2 aneurysms combined stenting and coil embolization were performed. One was completely occluded, and the other had a tiny flow into the aneurysm, only confirmd by cervical ultrasound examination. No procedural complication or neurological symptoms and signs were recognized during these endovascular procedure. Endovascular therapy was effective and safe for the cervical carotid artery areurysms. However, the aneurysm sometimes became recanalized, and it is important to treat the recurrent aneurysm.

Congenital External Carotid Artery Aneurysm

An 8-month-old child presented with a right pulsatile neck mass. The tumor's rapid increase in size and respiratory problems prompted image evaluation. An external carotid artery aneurysm was found, which was compressing other neck structures. The patient underwent aneurysm resection and ligation at its insertion on the common carotid artery. Recovery was uneventful and no further aneurysms on other arteries were found.

Extracranial carotid arteries aneurysms in children

Extracranial carotid artery aneurysms (ECAAs) are very rare conditions in children but carry a great potential of thromboembolic episodes and ruptures. To determine the clinical and therapeutic characteristics of ECAA in children in our department, we reviewed the patients' records and completed the data from phone correspondence, written survey, and clinical examination. From January 1981 to June 2006, 4 patients younger than 18 years were surgically treated for ECAA in our department. They were 3 boys and 1 girl. A medical history of tonsillectomy was reported in 3 patients. The aneurysm was symptomatic in all of the patients, local signs being present in every patient. The aneurysm caused hemispheric symptoms in 1 patient and finally stroke. The aneurysms were located in the common carotid artery, in the external carotid artery, and 2 in the internal carotid artery. The cause was congenital, mycotic, and traumatic (post tonsillectomy); for 1 patient, the etiology remained unknown. Aneurysm resection and interposition with vein graft were performed in 3 patients. The external carotid artery aneurysm was resected without reconstruction. There was no perioperative death or stroke. During the early follow-up period, 1 patient had a transient dysphagia and another a transient facial palsy. The patient with preoperative stroke remained with a neurologic deficit. All these patients were followed since the operation. The patient operated on in 1981 is asymptomatic after 25 years, but the graft became occluded 3 years after the operation. The patient who had recurrent attacks is still with residual neurologic deficit. The 2 other patients are without complains; the reconstructions remain patent. Although very rare, ECAA can be encountered even in the pediatric population. The past medical history may reveal a tonsillectomy, although the relation may not be easy to establish. Local signs may be accompanied by hemispheric thromboembolic complications, rupture, and bleeding. Therefore, surgical treatment is indicated, but can be challenging according to the anatomical location of the aneurysm.

Carotid Artery Aneurysms: Serbian Multicentric Study

This multicentric Serbian study presents the treatment of 91 extracranial carotid artery aneurysms in 76 patients (13 had bilateral lesions). There were 61 (80.3%) male and 15 (19.7%) female patients, with an average age of 61.4 years. The aneurysms were caused by atherosclerosis in 73 cases (80.2%), trauma in six (6.6%), previous carotid surgery in six (6.6%), tuberculosis in one (1.1%), and fibromuscular dysplasia in five (5.5%). The majority (61 cases or 67%) of the aneurysms involved the internal carotid artery, 29 (31.9%) the common carotid artery bifurcation, and one (1.1%) the external carotid artery. Forty-five (49.4%) aneurysms were fusiform, while 46 (50.6%) were saccular. Twenty-nine (31.9%) cases were totally asymptomatic at the time of diagnosis. The remainder presented with compression in 14 (15.4%) cases, stroke in 11 (12.1%) cases, transient ischemic attack in 33 (36.3%) cases, and rupture in four (4.4%) cases. In cases where the aneurysm involved the internal carotid artery, four surgical procedures were performed: aneurysmectomy with end-to-end anastomosis in 30 (33.0%) cases, aneurysmectomy with vein graft interposition in 20 (22.0%) cases, aneurysmectomy with anastomosis between external and internal carotid artery in eight (8.8%) cases, and aneurysmectomy followed by arterial ligature in three cases. One case of external carotid artery aneurysm also was treated by aneurysmectomy and ligature. Aneurysm replacement with Dacron graft was performed in 29 (31.9%) cases where common carotid artery bifurcation was involved. Two (2.2%) patients died after the operation due to a stroke. They had ruptured internal carotid artery aneurysm treated by aneurysmectomy and ligature. Including these, a total of five (5.5%) postoperative strokes occurred. In two (2.2%) cases, transient cranial nerve injuries were found. Excluding the five patients who were lost to follow-up, 69 other surviving patients were followed from 2 months to 12 years (mean 5 years and 3 months). In this period, there were no new neurological events and all reconstructed arteries were patent. Three patients died more than 5 years after the operation, due to myocardial infarction. Aneurysms of the extracranial carotid arteries are rare vascular lesions that produce a high incidence of unfavorable neurological sequelae. Because of their varied etiology, location, and extension, different vascular procedures have to be used during repair of extracranial carotid artery aneurysms. In all of these procedures, an aneurysmectomy with arterial reconstruction is necessary.

External Carotid Artery Aneurysm Developing After Embolization of a Ruptured Posterior Inferior Cerebellar Artery Aneurysm in a Patient With Cervicocephalic Fibromuscular Dysplasia-Case Report-

A 30-year-old man presented with an aneurysm of the left posterior inferior cerebellar artery manifesting as subarachnoid hemorrhage and cerebellar infarction. Angiography demonstrated string-of-beads sign typical of fibromuscular dysplasia (FMD) in the extracranial carotid and vertebral arteries. The aneurysm and the parent artery were successfully embolized with Guglielmi detachable coils. Severe vasospasm developed 1 week after admission, and was treated several times by selective injection of vasodilator. A new aneurysm of the left external carotid artery became evident 1 month later, whereas only slight dilation had previously been apparent. This angiographic sequence demonstrated a new arterial dissection. Despite the possibility of damage to the artery during multiple catheterizations, arterial wall changes caused by FMD appear to have been primarily responsible. This case emphasizes the need for particular care in performing vascular interventional procedures in the presence of FMD.

Giant External Carotid Aneurysm: A Rare Cause of Dyspnoea, Dysphagia and Horner's Syndrome

We report a case of life-threatening giant external carotid artery (ECA) aneurysm. The 89-year-old patient presented with severe dyspnoea and dysphagia with Horner's syndrome and cluster headache. Surgical repair with ECA ligation and reconstruction of the internal carotid artery using a prosthetic PTFE graft was successfully performed. The compressive symptoms promptly resolved in the early post-operative period.

Giant External Carotid Aneurysm: A Rare Cause of Dyspnoea, Dysphagia and Horner's Syndrome

We report a case of life-threatening giant external carotid artery (ECA) aneurysm. The 89-year-old patient presented with severe dyspnoea and dysphagia with Horner's syndrome and cluster headache. Surgical repair with ECA ligation and reconstruction of the internal carotid artery using a prosthetic PTFE graft was successfully performed. The compressive symptoms promptly resolved in the early post-operative period.

Bilateral External Carotid Artery Aneurysms

A 60-year-old female was found on a physical examination to have bilateral palpable pulsatile neck masses. She denied local pain, cranial nerve compressive symptoms, or symptoms of cerebral ischemia. Duplex ultrasonography demonstrated bilateral 1.5 x 2.2 cm external carotid artery aneurysms. Isolated bilateral external carotid artery aneurysms were confirmed by computed tomography and angiography. The patient has been treated conservatively, and at 4-year follow-up, she remains asymptomatic, and the carotid artery aneurysms are unchanged in size.

Mycotic Aneurysm of the External Carotid Artery as a Complication of Bacterial Endocarditis: Endovascular Exclusion with an Uncovered Stent

Wepresent a case of a mycotic aneurysm of the leftexternal carotid artery treated endovascularly with anuncovered stent.Case ReportA 37-year-old man with a long history of drug abusewas admitted to hospital with fever, headache andarthralgiaof5weeksduration.Thepatientwasknownto be sero-positive for hepatitis B and C. Investigationof the fever, due to septicemia, revealed endocarditisand severe mitral valve regurgitation. The patientdeveloped a bulky pulsatile enlarging mass in the leftcervicalregion.Digitalsubtractionangiography(DSA)performed on the same day revealed a saccularaneurysm (18.6£ 13.2 mm) arising from the leftexternal carotid artery (Fig. 1).Due to the co-morbidity of the patient it wasdecided to perform a percuteanous endovascularintervention rather than open surgical repair. Using atransfemoral approach a 7-French guiding catheterwas placed in the proximal external carotid artery anda stent (Aku-Link, Guidant) was deployed underbiplanar road map control. The self-expanding stent(5 mm in diameter £ 20 mm long) covering the largeneck (13 mm) of the saccular aneurysm was dilatedwith a balloon catheter (UltraSoft, Boston Scientific) toensure good wall apposition (Fig. 2(a)). No additionalcoil was applied and no complications occurred.Angiography following stent placement revealed thatthe flow in the aneurysm was considerably reducedwith no compromise to the flow in the external carotidartery (Fig. 2(b)). Colour-coded Doppler sonography 2days later showed total occlusion of the aneurysm,which was confirmed by MRA 1 week later. The initialantibiotic treatment with penicillin and gentamicinwas continued for 6 weeks. The severe mitral valveregurgitation required valve replacement 5 monthslater. The CT-scan at 6 month after stenting showed norecurrence of the aneurysm with normal contrastenhancement in the left external carotid artery.DiscussionThe pathogenesis of mycotic aneurysm varies;approximately 45% result from general infectionwith septicemia.

Occlusion of Internal Carotid Artery and Formation of Anterior Communicating Artery Aneurysm in Cervicocephalic Fibromuscular Dysplasia —Follow-up Case Report—

A 44-year-old female with cervicocephalic-fibromuscular dysplasia (FMD) suffered a subarachnoid hemorrhage 10 years after presenting with left impaired extraocular movement. Carotid and vertebral angiography had shown string-of-beads sign in the left external carotid artery and fusiform aneurysms in the left carotid cavernous portion and in the left vertebral artery. On admission, the left carotid angiogram showed complete occlusion of the left internal carotid artery and the right carotid angiogram showed a new anterior communicating artery aneurysm. The territory of the left middle cerebral artery was supplied from the right internal carotid artery via the anterior communicating artery and from the basilar artery via the posterior communicating artery. Occlusion of the main arteries is rare in the clinical course of FMD. We suggest that hemodynamic stress due to occlusion of the internal carotid artery contributed to formation of the anterior communicating artery aneurysm, possibly associated with intrinsic changes of the arterial wall induced by FMD.

前頭蓋窩硬膜動静脈奇形に外頸動脈末梢部動脈瘤を合併した1例

前頭蓋窩硬膜動静脈奇形(dAVM)に外頸動脈末梢部の動脈瘤を合併した1例を報告した.症例は53歳の男性で,右前頭葉の脳内出血にて発症した.脳血管撮影では右嗅窩部にnidusを有するdAVMおよび左外頸動脈末梢部に動脈瘤を認めた.dAVMに対してはnidus.coagulationおよびdrainer dissectionを施行し,外頸動脈末梢部の動脈瘤に対しては,後日embolizationを施行した.本症例に認められたdAVMと外頸動脈末梢部の動脈瘤は血行力学的な関係はなく,いずれも稀な疾患であることより,外頸動脈の発生段階における異常により発生したものと考えられた.

Traumatic external carotid artery aneurysm causing facial nerve paralysis: A case report

A case is reported of traumatic external carotid artery aneurysm causing facial paralysis. The aneurysm was successfully treated surgically.

Port wine nevus associated with ipsilateral saccular aneurysms: Treatment by intraarterial balloon trapping

A 21-year-old woman with a port wine nevus presented with ipsilateral monocular visual loss. A computed tomography scan of the brain revealed a round suprasellar mass. Angiography demonstrated aneurysm of the right external carotid artery, and petrous, cavernous, and giant ophthalmic internal carotid aneurysms. Four detachable balloons were deployed with arteriographic guidance, resulting in occlusion of the right carotid artery. The association of aneurysms and phakomatoses is discussed. The use of detachable balloons in the treatment of nonresectable aneurysms represents a safe and advantageous option. The use of detachable balloons for carotid occlusion has proven to be an effective modality in the treatment of giant supraclinoid and carotid-cavernous aneurysms. Giant intracranial aneurysms have been surgically treated with carotid ligation proximal to the aneurysm and by direct approach using microsurgical technique. In cases in which direct ligation is not possible balloon occlusion represents an effective alternative. This case illustrates treatment by carotid trapping performed entirely with intraarterial balloons. In addition the association of saccular aneurysms in a patient with a port wine facial nevus is reported.