Aneurysm Of Common Carotid Artery Research Articles

Aneurysm of the Extracranial Carotid Artery with Spontaneous Echo Contrast Revealed by Duplex Sonography

A 56-year old male patient without cerebrovascular disease or risk factors presented with a painless, pulsatile right-sided cervical swelling. Ultrasonography showed a large aneurysm of the right common and internal carotid artery with homogeneous thickening of the vessel wall as well as a parietal thrombus and a dilation of the left common and internal carotid artery with markedly reduced blood flow velocities. In the enlarged lumen of the right internal carotid artery spontaneous echo contrast was apparent with slow, ineffective but orthograde blood flow motions. Ensuing diagnostic procedures revealed multiple aneurysms involving the aorta and its branches. Despite surgical removal of the aneurysm and glucocorticoid therapy, the patient died from a ruptured aneurysm of a coronary artery a few weeks later. Post-mortem examination showed panarteritis consistent with Takayasu's disease. Spontaneous echo contrast is a frequent echocardiographic finding in patients with atrial fibrillation and mitral stenosis, indicating decreased blood flow. This is associated with an increased risk of embolism. In our patient, spontaneous echo contrast indicated severely disturbed haemodynamics due to a large aneurysm of the carotid artery. In the rare case of multiple aneurysms, differential diagnosis should include dissections, infections, and connective tissue diseases. Takayasu's arteritis, however, should also be considered, which usually presents with stenoses, but may be associated with multiple aneurysms of the aorta or its branches. If the diagnostic criteria are present, immunosuppressive treatment should be initiated.

What Does It Take to Diagnose Behçet Disease?

Behçet disease is a systemic inflammatory disease of unknown etiology initially described as a triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis affecting young male adults. Internationally agreed diagnostic criteria have been proposed to assist in the diagnosis. We present the case of a 26-year-old African-American male who presented with right brachial plexopathy due to axillary aneurysm. Further evaluation revealed the presence of a common carotid artery aneurysm, superior vena cava, and left subclavian vein thrombosis. A few months later, he developed severe bilateral panuveitis with hypopyon, retinal vasculitis, and optic nerve inflammation. Although our patient had no recollection of oral or genital ulcers, the constellation of deep vein thrombosis, multiple arterial aneurysms, bilateral panuveitis, positive pathergy skin test, and elevated inflammatory markers led to the working diagnosis of Behçet disease. Arterial involvement occurs in 3%-5% of patients with Behçet disease and may manifest as either true or false aneurysms. Deep vein thrombosis is the most common venous manifestation and involvement of venae cavae and their tributaries is not uncommon. Anterior and posterior uveitis and retinal vasculitis not only have a prognostic value in Behçet disease but in this particular case supported the diagnosis. In conclusion, incomplete forms of Behçet vasculitis exist and clinicians should be alert to atypical presentations of the disease.

Bilateral common carotid artery aneurysms

Tracheal deviation was incidentally discovered on a chest X-ray of a 40-year-old man (Panel A). He had no focal complaints and the examination of his neck was unremarkable. However, a CT-scan revealed aneurysmal dilation of the proximal portion of both common carotid arteries (CCA) compressing the trachea (Panel B; R CCA/ L CCA, right/left common carotid artery) and a rightsided aortic arch. Both CCA had partial calcification, intraluminal thrombi, and an hourglass morphology. Panel A Panel B

Stent-Grafting for the Large Common Carotid Artery Aneurysm

Spontaneous large aneurysms of the common carotid artery (CCA) are rare. Treatment strategy has not yet been established. We treated a patient with a spontaneous large aneurysm of the CCA with a stent-graft. We hereby report the case of successful endovascular treatment and its angiographic and ultrasonographic outcome. Case A 64-year-old woman with a history of transient right-sided hemiparesis visited our outpatient clinic at November 20, 2003. In addition, she had suffered from the soft mass getting larger in the neck. Carotid ultrasonography showed a large aneurysm of the right CCA in her neck, and the large aneurysm was her palpable soft mass. Magnetic resonance angiography (MRA) and carotid arteriography displayed it clearly. However, no vascular lesions were found referable to transient right-sided hemiparesis. She had no history of serious neck or head traumas After showing some treatment options, she hoped to undergo endovascular treatment with a stent-graft at January 20, 2004. Pre-operative angiography showed the large right CCA aneurysm with 19 x11 x 6 mm in size and the diameter of the right CCA near the aneurysm was about 7 mm. Under local anesthesia, we introduced 10Fr long sheath type guiding catheter into the right femoral artery and navigated it proximal to the right CCA aneurysm. After systemic anticoagulation with heparin, we measured carefully the diameter of the aneurysm by IVUS (intra-vascular ultrasonography). Then, we navigated a microcatheter (RapidTransit, Cordis) inside the right CCA aneurysm through the left femoral artery for possible coil embolization. We successfully deployed a self-expandable stent-graft (PASSAGER 10 mm _ 40 mm, Boston Scientific) through the 10-Fr guiding sheath and dilated it sufficiently with an 8mm balloon catheter. Immediately after post dilatation, the stent-graft was expanded enough to contact the CCA wall, and the aneurysm disappeared on angiograms. Therefore, we didn't perform coil embolization. Post-procedure carotid arteriography showed no visualization of the aneurysm. Three-month and twelve-month carotid ultrasonography and arteriography demonstrated complete obliteration and no recurrence of the right CCA aneurysm.

A case of arterio-venous aneurysm of the left common carotid artery and internal jugular vein

A case of arterio-venous aneurysm of the left common carotid artery and internal jugular vein

Tortuous common carotid artery as a cause of dysphagia

Dysphagia lusoria can be caused by any type of vascular ring1 but is commonly associated with an aberrant left or right subclavian artery, a right aortic arch or a common carotid artery aneurysm.2

Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

Retropharyngeal and parapharyngeal infections in children: the Toronto experience

To review the Hospital of Sick Children, Toronto's experience of the diagnosis and management of retropharyngeal and parapharyngeal infections with particular emphasis on the role of computed tomography (CT) imaging in diagnosing the presence of an abscess. A retrospective analysis of all patients diagnosed with retropharyngeal and parapharyngeal infections from 1987 to 1999 was performed. Demographic data, presenting symptoms, season of presentation, management and complications were reviewed. The CT scans of 27 patients who underwent surgical treatment were retrospectively examined by two neuroradiologists who were blinded to the patient's history and outcome. The sensitivity, specificity and predictive values for the specific features and overall assessment were calculated. Fifty-four children were identified. There were 46 retropharyngeal infections, 6 parapharyngeal infections and 2 patients had both retropharyngeal and parapharyngeal infections. All patients were treated with parenteral antibiotics. Thirty-seven patients underwent surgical drainage and in 27 there was a positive finding of pus. The retrospectively assessed CT scans of the 21 patients who underwent surgery were found to have a sensitivity of 81% in detecting an abscess by CT scan but the specificity was 57%. There were four complications including mediastinitis, aspiration pneumonia, internal jugular vein thrombosis and common carotid artery aneurysm. All patients recovered but abscess recurred in five patients. Not all patients with retropharyngeal and parapharyngeal abscesses require surgery. Whilst CT scans are helpful in diagnosing and assessing the extent of these infections they are not always accurate in detecting an abscess. A decision to drain an abscess should therefore not be made based solely on the CT findings.

Biomathematical modeling and analysis of blood flow in an intracranial aneurysm

The basic hypothesis of this study is that the intracranial aneurysm may enlarge and rupture due to dynamic instabilities of the blood flow and pressure inside the aneurysm. The specific question we attempted to answer is: which parameter(s) of aneurysmal geometry can serve as a reliable predictor(s) for aneurysmal rupture? We consider an idealized cylindrical aneurysm of the human common carotid artery and develop a mathematical model of blood flow through a normal artery and aneurysm connected in series. The mathematical model is nonlinear. It comprises nonlinear rheological properties of the normal artery and aneurysmal materials, and the inertial and resistance properties of the blood flow. The model equations were solved numerically and analyzed by methods of nonlinear dynamics. The critical aneurysmal diameter (CAD) is defined as a boundary point between the stable and unstable states of the model equations. The results confirm that a limit point of flow stability can occur only for a certain difference between aneurysmal and artery radii which are pre-disposed from a difference in their material properties. It was shown that CAD is dependent on both aneurysmal length and age of patient. Finally, the results suggest that the ratio between aneurysmal and normal artery diameters is a more reliable predictor of the aneurysmal rupture than the diameter alone. We conclude that an aneurysm diameter twice that of the normal artery could be dangerous.

Composite graft replacement after aortic valvuloplasty in Takayasu arteritis

A 24-year-old woman had undergone valvuloplasty of the aortic valve and external reinforcement of an aneurysm of the ascending aorta during the active phase of Takayasu arteritis 1 year prior to admission to our hospital. On examination, she was diagnosed as having a large false aneurysm of the ascending aorta with annuloaortic ectasia and severe aortic regurgitation, bilateral common carotid artery aneurysms with a left internal carotid artery saccular aneurysm, and bilateral subclavian artery and right vertebral artery obstructions due to Takayasu arteritis. Because of the risk of rupture, surgical intervention was carried out in spite of the fact that aortitis was in the active phase.

Mycotic aneurysm of common carotid artery induced by Staphylococcus aureus infection after cervical reoperation.

The objective of this study was to define a novel type of mycotic aneurysm of the carotid artery arising after cervical reoperation. We retrospectively analyzed all staphylococcal mycotic aneurysms of the common carotid artery. These aneurysms had developed after reoperative thyroid or parathyroid surgery, including resection of the central lymph node compartment and cervical reexploration. Mycotic aneurysms were found in three patients, with an incidence of 0.77% (2/261) and 0.62% (1/161) for thyroid and parathyroid reoperations, respectively. Postoperatively, a lymphatic fistula and cervical hematoma emerged in all patients, as did cervical wound infections on days 3, 4, and 6. Deep wound infections were noted on surgical revision. Cultures grew exclusively Staphylococcus aureus, which was resistant to methicillin (MRSA) in one patient. Mycotic aneurysms were identified 1 week after cervical reoperation. One aneurysm was discovered incidentally on planned lavage. The other two aneurysms presented as severe arterial hemorrhages, resulting in exsanguination in one patient. The other two patients had their aneurysms replaced by saphenous venous autografts. There seems to be accelerated arterial media destruction with formation of mycotic aneurysms in staphylococcal wound infections after cervical reoperation. It is important to recognize this novel type of mycotic aneurysm, as it must be repaired immediately to anticipate imminent rupture.

Carotid artery reconstruction with a synthetic graft for aortitis syndrome

We performed a carotid artery reconstruction with a double velour knitted Dacron graft in a 33-year-old Japanese woman with a left common carotid artery aneurysm caused by the aortitis syndrome. After inflammatory signs resolved on steroid administration, a carotid artery reconstruction was performed. One month after the operation, the internal carotid artery was narrowed at the distal anastomosis site and 10 months later the same site showed aneurysmal dilatation. We conclude that it is important to control inflammation for a prolonged period and perform angiography regularly after such an operation.

Stent-grafting for the Large Common Carotid Artery Aneurysm

Spontaneous large aneurysms of the common carotid artery (CCA) are rare. Treatment strategy has not yet been established. We treated a patient with a spontaneous large aneurysm of the CCA with a stent-graft. We hereby report the case of successful endovascular treatment and its angiographic and ultrasonographic outcome. Case A 64-year-old woman with a history of transient right-sided hemiparesis visited our outpatient clinic at November 20, 2003. In addition, she had suffered from the soft mass getting larger in the neck. Carotid ultrasonography showed a large aneurysm of the right CCA in her neck, and the large aneurysm was her palpable soft mass. Magnetic resonance angiography (MRA) and carotid arteriography displayed it clearly. However, no vascular lesions were found referable to transient right-sided hemiparesis. She had no history of serious neck or head traumas After showing some treatment options, she hoped to undergo endovascular treatment with a stent-graft at January 20, 2004. Pre-operative angiography showed the large right CCA aneurysm with 19 x11 x 6 mm in size and the diameter of the right CCA near the aneurysm was about 7 mm. Under local anesthesia, we introduced 10Fr long sheath type guiding catheter into the right femoral artery and navigated it proximal to the right CCA aneurysm. After systemic anticoagulation with heparin, we measured carefully the diameter of the aneurysm by IVUS (intra-vascular ultrasonography). Then, we navigated a microcatheter (RapidTransit, Cordis) inside the right CCA aneurysm through the left femoral artery for possible coil embolization. We successfully deployed a self-expandable stent-graft (PASSAGER 10 mm _ 40 mm, Boston Scientific) through the 10-Fr guiding sheath and dilated it sufficiently with an 8mm balloon catheter. Immediately after post dilatation, the stent-graft was expanded enough to contact the CCA wall, and the aneurysm disappeared on angiograms. Therefore, we didn't perform coil embolization. Post-procedure carotid arteriography showed no visualization of the aneurysm. Three-month and twelve-month carotid ultrasonography and arteriography demonstrated complete obliteration and no recurrence of the right CCA aneurysm.

Anesthesia for Excision of Common Carotid Artery Aneurysm in a Patient with Human Immunodeficiency Virus Infection

Anesthesia for Excision of Common Carotid Artery Aneurysm in a Patient with Human Immunodeficiency Virus Infection

Endovascular repair of abdominal aortic aneurysms and other arterial lesions

This report describes our experience with endovascular stented graft repair of abdominal aortic aneurysms and other arterial lesions. Between September 1990 and April 1994, 57 patients were treated with endovascular stented grafts (50 with abdominal aortic aneurysms or iliac aneurysms; five with traumatic arteriovenous fistulas; one with an infected femoral false aneurysm; and one with a false aneurysm of the proximal right common carotid artery). The devices consist of either a Dacron or an autogenous vein graft sutured to a balloon-expandable stent. The stented grafts are placed through remote arteriotomies, advanced under fluoroscopic guidance to their predetermined sites, and secured into position. Forty of the 50 endovascular stented graft procedures used to treat abdominal aortic aneurysms or iliac aneurysms were considered successful, even though some secondary treatment was required in six patients (two open operations; four secondary endovascular procedures). The 10 failures include four early procedural deaths, one late procedural death, and five leaks. All five arteriovenous fistulas and the two false aneurysms were successfully treated with endovascular stented grafts. Although our experience with endovascular stented grafts has been promising, remaining problems require resolution, and further follow-up is needed. However, the potential advantages of these endovascular grafts warrant their continued evaluation.

Dolichoectatic aneurysm of common carotid artery: an animal model with histological correlation.

There is a limited understanding of the pathogenesis of dolichoectatic (dolicho = long; ectatic = dilated) aneurysms of elastic arteries. Therefore, we developed a model of dolichoectatic changes in elastic arteries by injecting porcine elastase into the media of the carotid artery of male New Zealand white rabbits. After 3 months, gross examination of the carotid arteries in vivo revealed dilated and tortuous vessels. The carotid arteries were then harvested, and cross-sections of the vessels were stained by the Verhoff-van Giesson stain. Histologically, the internal elastic lamina was dissolved in the most dilated areas. The elastic lamellae of the media were also digested and there was reorientation of the innermost medial smooth muscle layer. These gross and histologic changes were present in 80% of the treated carotid arteries and in none of the contralateral control vessels. Our study suggests the importance of the elastic lamellae for the maintenance of tubular shape and length of the carotid artery and describes a new chronic animal model of dolichoectatic aneurysm of the common carotid artery.

A common carotid artery aneurysm causing severe dysphagia

Extracranial carotid artery aneurysms are rare, but are occasionally recognized as causing dysphagia. These aneurysms generally occur at or above the bifurcation. Here we present what we believe is a unique case: a common carotid artery aneurysm compressing the upper oesophagus, and mimicking the obstruction of a post-cricoid carcinoma.

A False Aneurysm of the Proximal Common Carotid Artery: Evaluation and Management—A Case Report

A symptomatic proximal common carotid artery false aneurysm that oc curred ten years after the repair of an arteriovenous fistula caused by a stab wound to the neck was repaired by a reverse saphenous vein graft to restore continuity from the aortic arch to the common carotid artery.

A Case of Behcet's Disease with a Rapidly Enlarging Aneurysm in the Common Carotid Artery.

A 16-year-old boy had incomplete Behçet's disease with common carotid artery aneurysm and an ulcer in the transverse colon. To our knowledge, this complication in the carotid artery has been previously reported in only 6 cases. Arterial repair and high-dose corticosteroid therapy (pulse therapy) were successful.

LEFT COMMON CAROTID ARTERY ANEURYSM -REPORT OF A CASE-

Common carotid artery aneurysms are uncommon. A case of left common carotid artery aneurysm is reported.A 76-year-old female was admitted complaining of a pulsating mass on the left side of the neck. Preoperative angiogram revealed a saccular aneurysm of the left common carotid artery. With simple clamps of the common, internal and external carotid arteries, aneurysmectomy and arterial reconstruction by patch plasty were performed. The clamping time was 31 minutes. The postoperative period was uneventful except hoaseness. The patient was discharged without any neurological deficit.Occulusion test of the common carotid artery gives us useful information to determine the common carotid arterial reconstruction under simple clamping.