Extracranial Carotid Artery Aneurysms Research Articles

Carotid tortuosity is associated with extracranial carotid artery aneurysms.

Tortuous arteries may be associated with carotid dissection. The intima disruption caused by a carotid dissection is a possible cause of extracranial carotid artery aneurysms (ECAAs). The aim was to investigate if carotid tortuosity is also associated with ECAA in patients without presence or history of a carotid artery dissection. A retrospective case-control study was performed including 35 unilateral ECAA patients (cases) and 105 age- and sex-matched controls. Tortuosity was expressed as tortuosity-index (TI), curvature, and torsion measured on computed tomography angiography (CTA) data in 3Mensio Vascular and MATLAB by two independent investigators. Primary comparison was tortuosity in ipsi- versus contralateral carotid artery within the cohort of ECAA patients. Secondary comparison was tortuosity with ipsilateral carotid arteries in control patients. All observations were assessed on inter- and intra-operator reproducibility. Carotid tortuosity was comparable within the cohort of ECAA patients (Spearman correlation 0.76, P<0.001), yet distinctively higher in comparison with unilateral controls. After adjustment for patient characteristics, presence of ECAA was associated with TI (β 0.146, 95% CI: 0.100-0.192). All tortuosity observations showed excellent inter- and intra-operator reproducibility. Carotid tortuosity seems to be a risk factor for development of ECAA. Surveillance of individuals with increased carotid tortuosity therefore potentially ensures prompt diagnosis and treatment of ECAA. However, future research should investigate if persons with an increased tortuosity do indeed develop ECAA.

Treatment Of An Extracranial Carotid Artery Aneurysm With Flow Diverter Stents And Coil Embolization

Extracranial carotid artery aneurysms (ECAAs) are uncommon. Although the true incidence and natural history of ECAAs are largely unknown, case series report a high risk of transient ischemic attack, stroke, or rupture if left untreated. Open surgical repair and endovascular therapy are both reasonable options depending on the size and location of the aneurysm.

Comprehensive Network Meta-analysis of Outcomes for the Treatment of Extracranial Carotid Artery Aneurysms

Untreated extracranial carotid artery aneurysms (ECCAs) increase stroke and mortality risk. Current studies have only evaluated surgical management. We compared the outcomes between (1) conservative treatment, (2) open repair, and (3) endovascular repair of ECCAs through a network meta-analysis.

Delayed Development of Aneurysmal Dilatations in Patients with Extracranial Carotid Artery Dissections

Dissection of the carotid artery (CaAD) may result in aneurysm formation. The present study was undertaken to evaluate the time of onset of post-dissection extracranial carotid artery aneurysms (ECAA) following CaAD, and to analyse independent risk factors for the development of these aneurysms. From four European stroke centres, 360 patients with extracranial CaAD were included. The time between the estimated dissection onset and aneurysm formation was analysed, and the clinical risk factors increasing the probability of aneurysm were assessed. The median duration of follow up was 5.2 months (range 0 - 24 months). A total of 75 post-dissection ECAAs were identified in 70 patients (19.4%, 95% confidence interval [CI] 15.7 - 23.8). In 52 of 70 (74%) patients, the ECAA was diagnosed at the initial clinical work up of CaAD diagnosis, with the median estimated time of dissection onset to ECAA diagnosis being six days (interquartile range [IQR] 0 - 25). In the remaining 18 (26%) patients who had normal carotid arteries at the initial imaging, the aneurysm diagnosis was made a median of 6.2 months (189 days) from the original imaging (IQR 128 - 198). A Cox proportional hazards model showed that both multiple artery dissections (hazard ratio [HR] 2.58, 95% CI 1.54 - 4.33) and arterial tortuosity (HR 1.79, 95% CI 1.08 - 2.95) were associated with presence of ipsilateral ECAA. This post hoc cohort analysis showed substantially delayed development of ipsilateral ECAA in patients with CaAD, months after baseline. Multiple dissections and arterial tortuosity are associated with the presence of ECAA and can be used in future prediction models of ECAA development in patients with CaAD.

O065 Mycotic extracranial carotid artery aneurysms: a systematic review

Abstract Introduction Mycotic extracranial carotid artery aneurysms are rare and their management variable due to a lack of evidence assessing outcomes. We undertook a systematic literature review to assess this. Methods Following PRIMSA guidelines, 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, pseudoaneurysm. Aneurysm, infected and carotid artery disease” subject headings were used. Titles and abstracts were screened before full text papers were reviewed. Results 193 such aneurysm cases were identified from 154 sources. Patients were predominantly male (71.4%) and age ranged from 6 months to 89 years old. The commonest presentations were a neck mass and fever, but included haemorrhage, respiratory distress and neurological 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 become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases there was antibiotic treatment alone. In the open surgery treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. Conclusion Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer complications than open surgical management and is recommended. Take-home message Carotid infected aneurysms are rare. They arise from direct spread of a staphylococcus or tuberculous infections. Endovascular management offers the best results.

Mycotic Extracranial Carotid Artery Aneurysms: A Systematic Review

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.

Comprehensive Network Meta-Analysis of Outcomes for the Treatment of Extracranial Carotid Artery Aneurysms

Extracranial carotid artery aneurysms (ECCAs) are rare and associated with increased stroke and mortality if left untreated. Current studies have only evaluated surgical management; thus, our comprehensive review compared the outcomes between (1) conservative treatment, (2) open repair, and (3) endovascular repair.

Management strategy for extracranial carotid artery aneurysms: A single-center experience.

This single-center, retrospective study aimed to describe the anatomic and clinical characteristics of extracranial carotid artery aneurysms (ECAAs) and to compare various ECAA management strategies in terms of outcomes.A total of 41 consecutive patients, who underwent treatment for ECAAs between November 1996 and May 2020, were included in this study. The ECAAs were anatomically categorized using the Attigah and Peking Union Medical College Hospital (PUMCH) classifications. The possible study outcomes were restenosis or occlusion of the ipsilateral carotid artery after treatment and treatment-associated morbidity or mortality.The 41 patients were stratified into three groups according to the management strategies employed: surgical (n = 25, 61.0%), endovascular (n = 10, 24.4%), and conservative treatment (n = 6, 14.6%). A palpable, pulsatile mass was the most common clinical manifestation (n = 16, 39.0%), and degenerative aneurysms (n = 29, 65.9%) represented the most common pathogenetic or etiological mechanism. According to the Attigah classification, type I ECAAs (n = 24, 58.5%) were the most common. Using the PUMCH classification, type I ECAAs (n = 26, 63.4%) were the most common. There was a higher prevalence of Attigah type I ECAAs among patients who underwent surgical treatment compared with those who underwent endovascular treatment (64.0% vs 40.0%, P = .09), whereas patients with PUMCH type IIa aneurysms were more likely to receive endovascular treatment (12.0% vs 30.0%). False aneurysms were more likely to be treated using endovascular techniques (20% vs 70%, P = 0.02). Except for two early internal carotid artery occlusions (one each among patients who underwent surgical and endovascular treatments, respectively), there were no early or late restenoses or occlusions during follow-up. Cranial nerve injuries were noted in three patients after surgical treatment, and late ipsilateral strokes occurred in two patients (one each among patients who underwent endovascular and conservative treatment, respectively). There were no other treatment-associated complications or deaths during the study period.Conclusions:Both surgical and endovascular treatments could be performed safely for ECAAs with good long-term results according to anatomic location and morphology.

Surgical and Endovascular Management of Extracranial Carotid Artery Aneurysms, Outcomes from the American College of Surgeons - National Surgical Quality Improvement Program

A retrospective review of the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) between 2013 and 2017. Of 139 patients with extracranial carotid artery aneurysms, there were significantly more postoperative strokes in the 19 patients treated with endovascular intervention (16%) than in the 120 patients treated with open surgery (4%). However, patients treated with endovascular intervention were more likely treated for emergent indications than the open surgical group (26% vs 7%, respectively). Postoperative stroke rates trended higher with endovascular approaches to treat carotid artery aneurysms, perhaps owing to a greater proportion of emergency procedures.

Management anesthesia in carotid artery aneurysm caused by a Behcet’s disease: A case report

Objective: Arterial manifestations of Behcet’s disease are challenging and can lead to fatal complications. One of the causes of carotid aneurysm is Behcet’s disease. Extracranial internal carotid artery aneurysms are rare. This aneurysm is rare but important because it is associated with a high risk of neur thromboembolic events, cranial nerve damage, and rupture. Method: We describe a 19-year-old man with a history of Behcet’s disease who presented with a gradual enlargement of the right neck mass with shortness of breath when he is supine. Result: This report examines the challenges of treating carotid aneurysms by spreading to the mediastinum in a patient with Behcet’s disease. Conclusion: It is important to pay attention to the need for awake intubation by expanding to the mediastinum.

Bilateral Carotid Aneurysms Secondary to Catastrophic Antiphospholipid Syndrome in a Patient with Differential Diagnosis of Polyarteritis Nodosa

Background: Extracranial Carotid Artery Aneurysm is considered a therapeutic and diagnostic challenge. In an unprecedented way in the literature, we describe an aneurysm originating from the Catastrophic Antiphospholipid Syndrome. Case Presentation: A 25-year-old male patient came to the Emergency Room of the ABC University Hospital in Sao Bernardo do Campo referring to bilateral neck pain for 1 month, associated with carotid aneurysms. Due to the severity and urgency of the clinical condition, immediate surgical therapy was performed without a definitive etiological diagnosis. The initial morphological analysis of the carotid artery suggested a diagnosis of Polyarteritis Nodosa. After anamnesis, physical examination, the use of a specific primary vasculitis algorithm, and a review of the pathological anatomy was requested, which showed bilateral carotid aneurysms secondary to catastrophic antiphospholipid syndrome. Conclusion: It remains evident that Extracranial Carotid Artery Aneurysm-related morbidity and mortality caused by Catastrophic Antiphospholipid Syndrome are influenced by a quick and correct diagnosis.

Bilateral Extracranial Carotid Artery Aneurysm: case report

Bilateral Extracranial Carotid Artery Aneurysm: case report

Surgical and Endovascular Management of Extracranial Carotid Artery Aneurysms, Outcomes From the American College of Surgeons, National Surgical Quality Improvement Program

Extracranial carotid artery aneurysms (ECAA) are rare and consequentially understudied; yet multiple management strategies for ECAA have been pursued. The goal of this study was to compare rates of stroke and cardiac events following surgical or endovascular management of ECAA utilizing the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP). The ACS-NSQIP database was queried for patients with both selected procedure codes and diagnostic codes specific for ECAA. 139 patients, 0.2% of carotid procedures, were located within ACS-NSQIP from 2013-2017. The endovascular group (n=19) had a higher proportion of emergency procedures than the open surgical group (n=120). Post-operative strokes in the endovascular group (n=3, 15.8%) were not significantly higher than the open surgical group (n=5, 4.2%; P=0.078). One cardiac event (0.7%) in the cohort occurred in the surgical group. This study provides insight into trends in national management of ECAA. Post-operative stroke rates trended higher with endovascular approaches, perhaps due to traumatic presentation as this group had a higher proportion of emergency procedures. Additionally, this study suggests patients with ECAA may have less cardiac burden than their peers with carotid stenosis.

Flow diversion device for the management of an extracranial internal carotid artery aneurysm.

Our patient is a 60-year-old woman with a history of hypertension, hypothyroidism, and glossal hemangioma. She works as a standardized patient actor in our simulation center. A neck ultrasound scan performed during one of the simulation sessions demonstrated a left internal carotid artery aneurysm, which prompted a consultation with Vascular Surgery. She denied any symptoms associated with this aneurysm. On physical examination, there was a palpable pulsatile mass below the left mandibular angle. On computed tomography angiography, a 2.3- × 1.9- × 2.2-cm saccular aneurysm of the extracranial left internal carotid artery was noted (A). After multidisciplinary discussion, the decision was made to proceed with endovascular treatment using flow diversion due to the patient's desire of avoiding a scar in the neck, aneurysm size, and risk for thrombus formation and embolization. A 5.0- × 25-mm Pipeline flow-diversion device (PED; Medtronic) was deployed across the lesion with no event. The patient was observed overnight and discharged the following day with a normal neurological examination and on aspirin 81 mg and clopidogrel 75 mg daily as an antiplatelet regimen. On 1-month follow-up computed tomography angiography, the stent demonstrated excellent apposition to the wall of the artery and excellent flow through this vessel (B). Extracranial carotid artery aneurysm has a prevalence of 0.4%-1% among all peripheral artery aneurysms.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar The neurologic symptoms experienced by patients include transient ischemic attacks and ischemic strokes.2Welleweerd J.C. den Ruijter H.M. Nelissen B.G. Bots M.L. Kappelle L.J. Rinkel G.J. et al.Management of extracranial carotid artery aneurysm.Eur J Vasc Endovasc Surg. 2015; 50: 141-147Google Scholar The first successful treatment for an aneurysm in this location was performed by Sir Astley Cooper in 1808 through ligation of the proximal carotid artery.3Kraemer C.J.K. Zhou W. Carotid aneurysm review.Int J Angiol. 2019; 28: 17-19Google Scholar Then, in 1952, Dimtza4Dimtza A. Aneurysms of the carotid arteries; report of two cases.Angiology. 1956; 7: 218-227Google Scholar reported the first successful resection with end-to-end anastomosis. In the past 10 years, with the development of endovascular techniques, the treatment options of carotid artery aneurysms have included open surgery, endovascular procedures, and hybrid techniques.1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar A review published by Qiu et al1Qiu J. Zhou W. Zhu X. Zhou W. Zeng Q. Huang L. et al.Treatment of extracranial carotid artery aneurysm: fifteen years' experience at a single institution.Ann Vasc Surg. 2020; 69: 174-181Google Scholar reports that the optimal management option for the treatment of carotid artery aneurysms is dependent on the morphology of the artery and the properties of the aneurysm. Recent advances in endovascular treatment allow for the utilization of flow diversion outside the skull, and treatment of extracranial internal carotid artery pseudoaneurysms with flow diversion has been shown to be safe and effective in selected patients.5Akinduro O.O. Gopal N. Hasan T.F. Nourollah-Zadeh E. Vakharia K. De Leacy R. et al.Pipeline embolization device for treatment of extracranial internal carotid artery pseudoaneurysms: a multicenter evaluation of safety and efficacy.Neurosurgery. 2020; 87: 770-778Google Scholar Informed consent was obtained from this patient for this publication.

Extracranial carotid artery aneurysm and surgical treatment

Extracranial carotid artery aneurysm and surgical treatment

Surgical and Endovascular Management of Extracranial Carotid Aneurysms, Outcomes from the American College of Surgeons, National Surgical Quality Improvement Program

Extracranial carotid artery aneurysms (ECAAs) are rare. Etiologies include dissection, atherosclerosis, trauma, mycotic infection, and iatrogenic. Patients are often asymptomatic at the time of diagnosis, but some present with a palpable mass or after an embolic cerebrovascular accident. Management of ECAAs includes thromboprophylaxis and surgical excision or exclusion of the aneurysmal segment. Intervention criterion for ECAAs has not been clearly delineated for either asymptomatic or symptomatic disease.

Takayasu's Arteritis with a Thrombosed Aneurysm on the Common Carotid Artery Causing Ischemic Stroke

Takayasu's arteritis is an inflammatory disease of unknown etiology that causes stenosis, occlusion, or dilatation of the aorta and its major branches, the pulmonary arteries, and the coronary arteries. The incidence of extracranial carotid artery aneurysm in patients with Takayasu's arteritis is reportedly 1.8-3.9%. We herein report a patient with Takayasu's arteritis who presented with transient left hemiplegia immediately after neck massage. Carotid ultrasonography revealed a thrombus within the fusiform aneurysm on the right common carotid artery. We speculated that fragmentation from the intra-aneurysmal thrombus was caused by neck massage.

Endovascular treatment of extracranial carotid artery aneurysms using self-expandable covered stent grafts: A single center retrospective study.

This study was aimed to evaluate the safety and efficacy of endovascular treatment of extracranial carotid artery aneurysms (ECAAs) using self-expandable covered stent grafts. All patients with ECAA at a single institution were reviewed from February 2014 to February 2020. Eight consecutive patients (three men, mean age 64.5 years) treated with endovascular repair with self-expandable covered stent graft were retrospectively reviewed. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. Access to ECAA was gained via a femoral approach or a direct puncture of common carotid artery after surgical exposure because of kinking of the aortic arch and common carotid artery. A self-expandable covered stent graft (Viabahn; W. L. Gore, Flagstaff, AZ) was deployed to exclude the aneurysm. Based on imaging features, there were five peudoaneurysms and three true aneurysms. The technical success rate was 100%. Cerebral protection devices were not used in all the patients during the procedures. Immediate absolute obliteration of the ECAA with no endoleak was documented in all the patients. Perioperative complications included one internal carotid-cavernous sinus fistula, one bleeding at the puncture site, and one stroke. The mean follow-up period was 35.5 months (range, 9-72 months). All the patients were alive, with an obligation rate of 100%. No transient ischemia attack, stroke, or reoccurrence of symptoms was identified during the follow-up period. Radiological examinations identified patency of the stent grafts and revealed no endoleaks, stent fracture, stent migration, or aneurysm rupture. Endovascular treatment of ECAAs with self-expandable covered stent grafts appears to be a safe and feasible alternative for traditional open surgery, especially in the challenging anatomy and instable physical conditions. Although cerebrovascular accidents can occur as the result of hemodynamic changes during the perioperative period, the minimal alternative can yield satisfactory midterm follow-up clinical outcomes.

A novel approach to high-grade carotid stenosis with concomitant extracranial carotid aneurysms using transcarotid artery revascularization

We present the novel application of transcarotid artery revascularization (TCAR) in two high-risk patients with high-grade internal artery stenosis and concomitant atherosclerotic extracranial carotid artery aneurysms (ECAAs). ECAAs account for <1% of arterial aneurysms and are usually clinically silent at presentation. Historically, the treatment of ECAAs has been via open reconstruction or stent grafting. TCAR is an effective alternative for carotid revascularization in high-risk patients with high-grade carotid stenosis, but has not been widely used for aneurysmal management. We report two cases to describe our management of concomitant carotid stenoses and ECCA with TCAR.

Endovascular and Hybrid Interventions for Extracranial Juxta-Skullbase Carotid Artery Aneurysms: Experience and Long-Term Results

BackgroundHybrid and endovascular procedures maybe effective and less invasive alternatives to open surgery for treatment of extracranial carotid artery aneurysm (ECAA), but the optimal management of juxta-skullbase ECAA is controversial. ObjectiveThis study evaluated the long-term effects of hybrid and endovascular procedures in treating juxta-skullbase ECAA. MethodsThe records of 9 consecutive patients who underwent hybrid or endovascular interventions for juxta-skullbase ECAA in a single center from April 2014 to May 2020 were retrospectively reviewed. ResultsFour patients presented with a pulsating mass, 1 with dysphagia, 1 with pain in the left temporal region, 1 with dizziness and headache, 1 with cerebral infarction, and 1 with dizziness and cerebral infarction. Seven true aneurysms, 1 false aneurysm, and 1 dissecting aneurysm were diagnosed with CTA in the 9 patients (mean age, 50.8±20.3 years; 1 male). The aneurysms were divided into two subgroups: 4 type I, and 5 type IIb according to a recent classification. Per schedule, 7 patients (4 type I and 3 type IIb) were treated with endovascular intervention, and 2 (type IIb) were treated with hybrid procedures. The technique success rate was 88.9%. One patient (type IIb) who was scheduled to be treated with an endovascular procedure was transferred to a hybrid procedure because of failure of the endovascular procedure. Eleven covered stents were implanted to exclude the aneurysms. During follow-up (mean duration 31.2±23.2 months), all aneurysms were proven excluded, no significant complication occurred, and preoperative symptoms resolved. One patient (type I) in the endovascular group had occlusion of the internal carotid artery but no symptoms; the internal carotid artery was patent in the other 8 patients. ConclusionsHybrid and endovascular procedures were found effective and durable alternatives to open operation for treatment of extracranial juxta-skullbase carotid aneurysm.