Extracranial Carotid Artery Aneurysms Research Articles

Endovascular and Hybrid Treatment of Extracranial Carotid Artery Aneurysms: Long- term Results From the multinational Carotid Aneurysm Registry

Endovascular and Hybrid Treatment of Extracranial Carotid Artery Aneurysms: Long- term Results From the multinational Carotid Aneurysm Registry

Long-Term Outcome Evaluation of Conservative Management for Extracranial Carotid Artery Aneurysms: Insights From the International Carotid Aneurysm Registry

Long-Term Outcome Evaluation of Conservative Management for Extracranial Carotid Artery Aneurysms: Insights From the International Carotid Aneurysm Registry

Extracranial Carotid Artery Aneurysm: An Institutuinal Review

Abstract Background: Extracranial carotid artery aneurysm (ECAA) is a rare condition, with varied symptoms and etiology. The current series describes the profile and treatment outcomes of those with ECCA. Materials and Methods: A record-based retrospective case study on 10 years of data from a hospital was done. Data on sociodemography including age and gender, symptoms, examination findings, radiological investigations, and management techniques were collected. Results: A case series of 12 cases presenting with different symptoms of extracranial internal carotid artery aneurysm are discussed. Age of the participants varied from being adolescents, adults, or elderly patients. Three-fourth of the cases were males. Pulsatile swelling in the neck was the most common presentation, though asymptomatic manifestations are also present. All 12 were managed by different techniques, with surgical resection and end-to-end anastomosis being the most common type of repair. All had good outcomes following treatment. Conclusion: ECCA has male predominance and occurs mainly in those above 50 years of age. The most common presentation is swelling in the neck and the most common management technique is open surgical repair.

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note.

Surgery is effective for extracranial internal carotid artery (EICA) aneurysms. However, the risk of cranial nerve injury associated with surgical repair, such as graft-assisted resection and extracranial-intracranial bypass techniques, is relatively high. Here, we report two cases of surgical treatment for EICA aneurysms and describe the surgical techniques and strategies to avoid cranial nerve injury. Two patients presented to our facility with an increasing cervical pulsatile mass and no neurological symptoms. Angiography showed a large aneurysm in the cervical internal carotid artery. Surgical treatment was performed to prevent rupture of the aneurysm. In both patients, the aneurysm was strongly attached to the vagus nerve. The aneurysm and vagus nerve were carefully dissected using a low-power bipolar (20 Malis; 3 watts), leaving connective tissue on the vagus nerve side. The aneurysm was detached from the vagus nerve without injury. Based on intraoperative findings, one patient underwent clipping, and the other underwent aneurysmectomy and primary closure for aneurysm obliteration and angioplasty. Both patients were discharged without any cranial nerve dysfunction. The selection of a strategy based on intraoperative findings and low-power bipolar cutting is important for the treatment of extracranial carotid artery aneurysms to preserve cranial nerves.

Recurrence of an extracranial internal carotid artery aneurysm treated with STA-MCA bypass and trapping due to neovascularization from an ascending pharyngeal artery: illustrative case.

Extracranial internal carotid artery aneurysms (EICAs) are rare. Although a high mortality risk has been reported in nonoperated cases, the optimal treatment for EICAs remains unknown. A 79-year-old female presented with painless swelling in the right neck. Imaging revealed a giant EICA with a maximum diameter of 3.2 cm. Superficial temporal artery-middle cerebral artery bypass and internal carotid artery (ICA) trapping were performed. Because the distal aneurysm edge was at the C1 level, the distal portion of the aneurysm was occluded by endovascular coiling, and the proximal portion was surgically ligated. Blood flow into the aneurysm disappeared after the operation. Three years postsurgery, enlargement of the aneurysm with blood flow from the ascending pharyngeal artery (APA) was detected. The EICA was resected after coiling the APA and ligating both ends of the aneurysm. Pathologically, neovascularization within the aneurysm wall was observed. Even if blood flow into an EICA disappears after ICA trapping, the EICAs can enlarge due to neovascularization from the neighboring artery. From the outset, removal of the aneurysm should be considered as a radical treatment strategy for giant EICAs.

Transcarotid stenting of extracranial carotid artery aneurysm with covered stents and flow reversal

IntroductionAn extracranial carotid artery aneurysm (ECAA) is a rare pathology comprising <1% of all arterial aneurysms. The etiology includes trauma, previous surgery, radiation, and infection. Treatment of ECAAs has evolved from open repair to endovascular repair with stenting. Reports of endovascular repair describe the transfemoral approach; however, little more than case reports are available describing the transcarotid approach for ECAAs. In this study, we describe a cohort of patients who safely underwent transcarotid repair of ECAAs. MethodsWe performed a retrospective medical record review of all cases of transcarotid stenting using covered stents for a carotid aneurysm within 11 different hospitals within the Memorial Hermann Health System from December 2019 through December 2022. Technical success is defined as coverage of the aneurysm with no endoleak. We report the patient demographics, clinical presentation, intraoperative metrics, and outcomes. ResultsSeven patients underwent transcarotid covered stent placement using flow reversal for neurologic protection. Their average age was 65 years, and four of the seven patients were men. Three patients presented with pain, two with transient ischemic attack, one with stroke, and one with a pulsatile mass. Technical success was 100%. All the patients were treated with transcarotid stenting, and the average aneurysm size was 13 mm. The average operative time was 69 minutes, and the flow reversal time was 9 minutes. No postoperative stroke, myocardial infarction, or death occurred. The average length of hospital stay was 2.7 days. ConclusionsA transcarotid approach for endovascular treatment of ECAAs was safe for this cohort of patients, with no postoperative death, stroke, or myocardial infarction. Also, the technical success was 100%.

Bilateral giant aneurysms of the carotid artery in one patient

Extracranial carotid artery aneurysms are uncommon, life-threatening diseases typically resulting from atherosclerosis. In this case report, a 32-year-old male patient with a bilateral carotid artery aneurysm is presented. After the aneurysmectomy, Dacron graft interposition was applied to the right carotid artery. It was attempted to manage the complications that developed in the postoperative period. These patients require a more detailed and multidisciplinary approach, both intraoperatively and postoperatively.

Hybrid treatment of large extracranial carotid artery aneurysm.

An extracranial carotid artery aneurysm (ECAA) is a rare condition. The major complications are rupture and thromboembolism. Therefore, treatment is generally recommended. We report the case of a young woman affected by an ECAA, with a cervical pulsatile mass. A multidisciplinary evaluation was performed to ensure the best treatment in terms of safety and efficacy, and the patient underwent hybrid treatment. The 6-month computed tomography angiogram revealed patency of the carotid artery stents and the venous graft, in the absence of any relevant complications. An ECAA is a serious clinical condition. The treatment is challenging, and a multidisciplinary evaluation and precise planning are recommended.

Viabahn-assisted sutureless anastomosis (VASA) repair of a complex internal carotid artery aneurysm.

Extracranial carotid artery aneurysms (CAAs) are extremely rare and often require surgical intervention to avoid complications such as local compression symptoms and thrombo-embolization. We present the case of a 63-year-old man with a history of hypertension, meningioma, and an incidental finding of a right saccular internal carotid artery aneurysm at the base of the skull. He underwent open surgical repair; nonetheless, end-to-end anastomosis was not feasible. As bailout, the internal carotid artery was successfully reconstructed with a novel Viabahn-assisted sutureless anastomosis technique (GORE, Viabahn). Postoperative clinical assessment revealed no complications, postoperative computed tomography angiography revealed a patent reconstruction, and the patient was discharged home uneventfully with 1-year clinical and computed tomography angiography follow-up without remarks. Hybrid procedure is a viable option for technically challenging carotid anastomoses near the skull base.

Transcarotid Stenting of Extracranial Carotid Artery Aneurysm With Covered Stents and Flow Reversal

Transcarotid Stenting of Extracranial Carotid Artery Aneurysm With Covered Stents and Flow Reversal

Acute periapical dental abscesses and increased risk for extracranial carotid artery aneurysms

Aim: To assess the prevalence of acute periapical abscesses (PAs) in patients with a history of extracranial carotid artery aneurysms (ECAA). Materials and methods: History of acute PAs and ECAA diagnosis was retrieved by searching the appropriate query in the database. All cases were diagnosed for acute PAs by calibrated dentists for patients admitted to urgent care. The odds ratio (OR) for the prevalence of acute PAs and its association with history of ECAA were then calculated. Results: The prevalence of acute PAs in patients with a history ECAA was significantly higher as compared to the general hospital patient population (p &lt; 0.0001). The OR was 5.5. Females were more affected than males by 1.7 folds (p &lt; 0.001). Whites were more affected than African Americans by 1.6 folds (p &lt; 0.00001). Conclusions: The high prevalence of acute PAs in patients with a history of ECAA may suggest an association between these two conditions warranting a thorough medical examination.

Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management

Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention.&#x0D; The aim. To improve the results of surgical treatment of ECAAs.&#x0D; Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography.&#x0D; Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%.&#x0D; Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.

Large Carotid Aneurysm: An Illustrative Case of Open Surgical Repair

Abstract Background Extracranial carotid artery aneurysms are rare and are often localized at the level of the carotid bulb or in the distal internal carotid artery. Generally asymptomatic until an embolic event or a local compression reveals their presence, the rupture is rare. Case Report We presented a case of a 68-year-old female referred to our hospital for a pulsatile mass on the right side of her neck with no other symptoms. The patient had a history of hypertension that was medically controlled. The duplex ultrasound confirmed the presence of a large internal carotid aneurysm. Angiotomography shows a large 5 cm diameter type 1 aneurysm of the right internal carotid artery and a type 1 2.7 cm diameter of the left carotid artery. Open surgery with aneurysmal resection and direct end-to-end anastomosis was performed with an uneventful course. Conclusion This is an illustrative case of managing large carotid aneurysms by open surgery.

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.