Extracranial Carotid Aneurysms Research Articles

Aneurisma gigante de arteria carótida interna extracraneal en un paciente trasplantado de corazón

Summary Introduction. Extracranial internal carotid aneurysms are uncommon lesions. The aetiology is nearly always atherosclerotic and they generally occur in men aged between 50 and 60 years old. We have not found any case reported in the literature as having an aneurysm of the internal carotid artery after having had a heart transplant. Clinical case. We report a 70 year old man who had had a heart transplant operation in 1994. He developed an extracranial internal carotid aneurysm, 4.5 cm in diameter, which was successfully treated by resection and graft insertion. We discuss aspects of the surgical technique and peri-operative management.

Therapiemöglichkeiten des Extracraniellen Karotis interna-Aneurysmas

Purpose: The purpose of this study is to compare surgical treatment of extracranial carotid aneurysms with endovascular treatment using stents and coils or stentgrafts.¶ Methods: In a retrospective study the data from 19 patients with 22 extracranial carotid aneurysms between 1987 and 1999 were analyzed. Annual clinical follow-up using duplex sonography and in some cases angiographic control was done.¶ Results: Fourteen aneurysms were reconstructed surgically, endovascular treatment was performed in eight cases. A temporary lesion of cranial nerves occurred in 26.6%, a permanent lesion in 6.6% of the surgically treated group. No neurological deficits were apparent. In the patient group which underwent endovascular treatment, 12.5% had a cerebral neurological deficit. In one case the treatment of a stenosis was necessary after 14 months.¶ Conclusions: Surgical reconstruction of extracranial carotid aneurysms is the method of choice. Endovascular treatment should be considered when aneurysms are inoperable or located high at the cranial base.

Management of Extracranial Carotid Artery Aneurysms:17 Years» Experience

Objectives:a retrospective review of seventeen-year (1980–1996) experience of the management of extracranial carotid artery aneurysms.Patients and methods:sixty-six aneurysms of extracranial carotid artery were seen in 63 patients. The diagnosis was confirmed by angiography in 51 patients and duplex ultrasonography in twelve. Twenty-eight (42%) patients had an atherosclerotic aneurysm, twenty-two (33%) had false aneurysms secondary to trauma, nine were congenital and seven were mycotic. All underwent aneurysm resection with saphenous-vein-graft interposition as the most common means of reconstruction.Results:one death occurred due to septicaemia in a diabetic patient with a mycotic aneurysm, giving an operative mortality of 1.5%. One patient had an immediate hemiparesis after carotid artery ligation, and three had a hemiparesis within 48 hours of operation (6.1%). After a change in technique to avoid a residual carotid stump, no further neurological problems were encountered in the following 28 patients.Conclusion:extracranial carotid aneurysms may be successfully managed with resection and reconstruction with autogenous saphenous vein. End-to-side anastomosis avoids a blind-ending stump which may be the source of emboli.

Contrast-enhanced MR angiography of the supra-aortic vessels in 24 seconds: a feasibility study

A contrast-enhanced, gradient-echo 3D pulse sequence providing angiographic information in 24 s was tested in five healthy subjects and used prospectively in 21 patients for the investigation of the cervical arteries. Indications included suspected stenosis of the carotid (in 13), or vertebral arteries (in 1), carotid dissection (3), variants of the branches of the aortic arch (2) and extracranial carotid aneurysms (2). The results in all patients were compared with those of intra-arterial digital subtraction angiography (DSA). In patients with carotid stenosis, they were also compared with high-resolution 3D time-of-flight (TOF) MR angiography (MRA). Good quality MR angiograms of the neck vessels were obtained with the fast 3D sequence in 20 of the 21 patients. One claustrophobic patient was unable to cooperate. The degree of internal carotid artery (ICA) stenosis was graded correctly (compared to DSA) in 21 of 24 cases (87.5%). Two mild stenoses were overestimated as moderate using the fast MR sequence and one high-grade stenosis was misdiagnosed as a complete occlusion. Carotid dissection was confirmed in one case and correctly excluded in two. Four extracranial ICA aneurysms in two patients, arterial variants and stenosis of the origin of the vertebral artery were correctly diagnosed using the contrast-enhanced MR angiogram. Three-dimensional TOF MRA was unsuccessful due to motion artefacts in half of the cases of ICA stenosis.

Atherosclerotic Aneurysms Following Carotid Endarterectomy with Dacron Patch Angioplasty: An Unreported Complication

The authors report 4 atherosclerotic extracranial carotid aneurysms (AECA) in 3 patients who had carotid endarterectomies with Dacron patch angioplasty (CEADP). This complication has not previously been reported with this patch material in this location. These AECAs were found in a group of 204 patients. Two hundred thirty-two arteries (1.7%) who had CEADP and who returned for regular follow-up from 3 months to 15 years postoperatively. Three aneurysms were excised after angiographic confirmation and replaced with autologous saphenous vein interposition grafts uneventfully. One of the three patients who had bilateral CEADP has since developed a contralateral aneurysm presumed to be an AECA but has refused angiography and surgery. This aneurysm remained essentially unchanged for two years after detection. The patient was then lost to follow-up. The diagnosis of AECA in the patients who were operated on was confirmed by histology. Dacron patch angioplasty as an adjunct to carotid endarterectomy is an accepted technique which yields satisfactory results. This report however, cautions about a significant complication which occurs late in the postoperative course of patients who have had this procedure.

副咽頭間隙感染後に続発した外頚動脈りゅう例

Mycotic aneurysms of the extracranial carotid artery are rare lesions. We describe a case of mycotic extracranial carotid aneurysms developing after a parapharyngeal space infection in a 65-year-old-man. The patient had a high fever because of tonsillitis, and it spread to the parapharyngeal space. After the inflammation had passed, a pulsatile mass appeared around the pharynx. Extracranial aneurysms are diagnosed by MRI and DSA (angiography), and are treated with intravascular techniques using mechanical detachable coil (MDC).

A CASE OF IATROGENIC PSEUDOANEURYSM OF THE CAROTID ARTERY

A case of iatrogenic pseudoaneurysm of the carotid artery is reported. The patient was a 55-year-old woman. After the operations of left middle cerebral arterial clipping for subarachnoidal hemorrhage and left superior neck ganglionectomy for left middle cerebral arterial spasms, she took an angiographic examination by way of left carotid arterial puncture. Twenty-five days after that examination, an expanding pulsatile tumor appeared on the left neck suddenly. Angiography revealed a pseudoaneurysm of the carotid artery. Emergency operation was performed on a diagnosis of impending rupture. The operative methods included total aneurysmectomy with partial excision of the common carotid artery and primary direct anastomosis. Probable major causes of an extracranial carotid aneurysm are atherosclerotic, non-specific inflammatory and traumatic, and iatrogenic pseudoaneurysm as this case is relatively rare. Though there is a questionable opinion of operative indication for atherosclerotic lesions, this case was thought to be an absolute candidate for operative indication. Here we also referred to the course of outbreak of the disease in this case.

Ruptured Mycotic Extracranial Carotid Aneurysm Treated by Excision, PTFE Graft Interposition, and Local Antibiotic Application—A Case Report

A very rare case of ruptured mycotic extracranial carotid aneurysm caused by Streptococcus pneumoniae is described. An eighty-one-year-old man with a painful swelling of the right side of the neck was operated upon. There was no available vein for graft interposition and no retrograde flow in the internal carotid artery. The patient was successfully treated by resection of the aneurysm, 6 mm ringed polytetrafluoro-ethylene prosthesis interposition, and preoperative and postoperative antibiotic therapy combined with local antibiotic application. Seven months after the operation the patient remains free from complications.

Bilateral Aneurysms of Extracranial Internal Carotid Arteries

A 52-year-old male was admitted because of right hemiparesis. Computed tomography scan showed a low-density area in the basal ganglia on the left side. Left carotid angiography showed an aneurysm of the extracranial internal carotid artery at the level of the C1-C2 vertebral body. Right carotid angiography also showed an aneurysm of the extracranial internal carotid artery. Because there were neither steno-occlusive changes in the intracranial vessels nor abnormality in the heart, the right hemiparesis seemed to be due to embolism from the extracranial aneurysm. Aneurysmectomy and end-to-end anastomosis of the left internal carotid artery were performed. Extracranial carotid aneurysms are rare conditions. In surgery on these aneurysms, ischemic changes of the brain during arterial clump must be detected and treated. Hypothermia, induced hypertension, and/or internal shunting have been used during arterial clump. The pathogenesis, symptoms, prognosis, and surgical treatments of these aneurysms are discussed.

Extracranial carotid artery aneurysms

Aneurysms of the extracranial carotid arteries are uncommon vascular lesions. During the period 1976 to 1986 we encountered 18 extracranial carotid aneurysms in 14 patients. The aneurysms were atherosclerotic (12 in 9 patients), congenital (3 in 2 patients), mycotic (1) and secondary (false aneurysms) after previous carotid surgery (2 in 2 patients). The patients presented with neurological symptoms (11) or a pulsating mass in the neck (2). In one patient the aneurysm was detected accidentally during angiography. From this study it became clear that "carotid aneurysm" is not a well defined entity. The "normal" configuration of the carotid bulb with its usually larger diameter, is in part a cause of the problem of definition. A recently described technique for predicting normal vessel diameters in stenosing lesions of the carotid arteries was retrospectively applied to all our patients with aneurysms. With these measurements, made on standard preoperative angiograms, it was possible to quantify the degree of dilatation, and confirm the diagnosis of aneurysm. Eleven of the 14 patients were operated on without mortality, no neurological deficits were seen as a result of the operation and minimal morbidity occurred in six patients. From this study we conclude that surgical correction of accessible carotid artery aneurysms is a relatively safe procedure and these lesions should be operated on irrespective of symptoms. This is the first report that gives clear guidelines for measuring dilatation of the extracranial carotid arteries and based on these guidelines we suggest criteria for the discrimination between physiological dilatation and pathological aneurysm formation, the latter condition being an indication for operation.

Haematemesis from distal extracranial carotid aneurysms

A 5-year-old white boy presented with life-threatening haematemesis from spontaneous rupture of an aneurysm of the high cervical internal carotid artery (ICA). The haemorrhage was controlled by emergency trap ligation of the distal ICA in the neck. The child made an excellent recovery and 7 years later has no neurologic deficit other than an Horner's syndrome. The diagnosis of an extracranial carotid artery aneurysm without a pulsatile lump may be very deceptive.

Extracranielle Aneurysmen der Arteria carotis interna - ein Hals-, Nasen-, Ohrenärztliches Problem?

The problem of high cervical internal carotid aneurysms is demonstrated in two patients. One patient presented with a massive intermittent bleeding in the nasopharynx, the second with a sudden paralysis of the cranial nerves 9-12. 2/3 of these extracranial internal carotid aneurysms are situated at the bifurcation of the common carotid artery and 1/3 are located proximal the skull base. These aneurysms can be "congenital" or traumatic in origin or may arise as a complication of otitis media or tonsillitis. Diagnosis should be established by arteriography. Even for asymptomatic aneurysms the present therapeutic concept consists of a multidisciplinary surgical approach with attempted vascular reconstruction, since spontaneous rupture may occur at any moment.

Aneurysm of the Extracranial Carotid Artery

Aneurysms of the extracranial carotid artery are rare vascular lesions. These aneurysms usually present to the otolaryngologist or vascular surgeon as a cervical or parapharyngeal pulsatile mass. Rupture and hemorrhage are unusual complications. Central nervous system symptoms secondary to embolism or thrombosis, however, are relatively common. Because of these serious complications, surgical resection of the aneurysm with restoration of arterial continuity is the treatment of choice. We describe herein three cases of the extracranial carotid aneurysm treated at the Mie University Hospital, Tsu, Japan, in the past two years. Surgical treatments include end-to-end anastomosis, saphenous vein autograft replacement, and direct closure utilizing an internal shunt, respectively, after resection of the aneurysm. In all patients, the postoperative course was uneventful, and angiography six weeks after the operation demonstrated good blood flow through the repaired artery.

Extracranial carotid aneurysms: Report of six cases and review of the literature

Ligation of atherosclerotic extracranial carotid aneurysms was described nearly 200 years ago, but resection and direct reconstruction of these unusual lesions currently are associated with less risk for perioperative neurologic complications as well as with durable late results. During an interval in which carotid endarterectomy was performed in over 1500 patients at The Cleveland Clinic, only six patients underwent surgical management of cervial carotid aneurysms. Aneurysm resection was performed in conjunction with reanastomosis of the internal carotid artery in two patients but required saphenous vein interposition grafts in four others. A temporary carotid shunt was employed routinely and was threaded through the harvested vein before its insertion whenever graft replacement was necessary. Although one vein graft required revision because of early thrombosis, no operative deaths or permanent strokes occurred in this small series. Each patient has remained asymptomatic throughout a maximum follow-up period of 6 years post-operatively.

Extracranial carotid aneurysms: Report of six cases and review of the literature

Extracranial carotid aneurysms: Report of six cases and review of the literature

Spontaneous Dissecting Cervical Carotid Artery Aneurysm

A unique case of a large dissecting cervical carotid artery aneurysm is presented. The lesion had probably started as a spontaneous dissection 2 years before the onset of ischemic hemisphere symptoms and represents one way in which such a dissection can evolve if unchecked. The usual presentation, angiographic findings, and possible treatments of dissecting extracranial carotid aneurysms are discussed briefly.

Spontaneous Dissecting Cervical Carotid Artery Aneurysm

Abstract A unique case of a large dissecting cervical carotid artery aneurysm is presented. The lesion had probably started as a spontaneous dissection 2 years before the onset of ischemic hemisphere symptoms and represents one way in which such a dissection can evolve if unchecked. The usual presentation, angiographic findings, and possible treatments of dissecting extracranial carotid aneurysms are discussed briefly.

Extracranial aneurysms of the carotid artery.

Aneurysms of the extracranial carotid artery represent a serious disease because of possible cerebral embolism and aneurysm rupture. Between 1960 and 1979, 28 aneurysms of the extracranial carotid artery were seen in 27 patients at our institution. Twenty-six of these patients noticed a pulsating tumor, 12 patients had neurological symptoms; 2 aneurysms were ruptured. Five times the external carotid artery, and 3 times the internal carotid artery were ligated without neurological symptoms. After aneurysm resection, the carotid artery was reconstructed in 4 cases by direct suture, and in 2 cases by patch angioplasty. Reconstruction was accomplished with a tube-graft in 9 instances, once an extra-intracranial shunt had to be performed in advance. Two patients developed neurological deficiencies after the operation (8.7%), in one of them these were permanent. In the follow-up, 20 patients were without symptoms (87%), 3 patients died after the operation (peri-operative mortality 13%). Out of the 5 non-operated patients 2 died after a short time: one of an acute myocardial infarction and one of an extensive cerebro-vascular infarction. Two patients with asymptomatic internal carotid aneurysm refused the operation and are without symptoms for 2 and 40 years respectively. Because of the potential risks of cerebro-vascular infarction and aneurysm rupture, good results of operative treatment call for an aggressive surgical approach in dealing with extracranial carotid aneurysms.

Surgical treatment of extracranial carotid aneurysms with excision and arterial restoration.

Surgical treatment of extracranial carotid aneurysms with excision and arterial restoration.

Resection of the extracranial internal carotid aneurysm

The problems encountered in the management of aneurysm of the extracranial portion of the internal carotid artery are discussed. A case report of successful resection of such an aneurysm is presented. Mild resolving neurologic deficit occurred. Various methods such as controlled hypertension, hypothermia, and shunting are discussed as a means to make this a safer procedure.