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Extracranial Internal Carotid Artery Aneurysms: A Review Of The Past 20 years
Shahin Pourrabbani, MD, Mauricio Szuchmacher, MD, K. V. Krishnasastry, MD, FACS.
North Shore LIJ Medical Center, Manhasset, NY, USA.
Objective(s):
Extracranial Internal Carotid Artery Aneurysm (ICAA) is rare and surgical repair accounts for less than 2% of all carotid operations. Their significance is linked to the natural history that, if left untreated, ICAA has a high incidence of significant cerebrovascular morbidity and mortality. In this study, we discuss the pathogenesis, clinical manifestation, diagnosis, and treatment options of this rare entity.
METHODS:
A systematic literature search was conducted using MEDLINE, Cochrane Library and PubMed databases on all articles pertaining to Extracranial internal carotid artery aneurysm published in the English language between January 1994 and January 2014. Following keywords were used: carotid artery aneurysms, extracranial carotid artery aneurysms, and extracranial internal carotid artery aneurysms. A total of 50 review articles were found, and exclusion criteria were intracranial aneurysms, traumatic and non-traumatic dissections, and non-internal carotid artery aneurysms.
Results:
Fifteen articles were included in this study. According to the review of 52 patients, Internal Carotid Artery Aneurysms tend to develop later in life, at an average age of 37.5 years (range, 3 to 76 years). Among ICAA patients, 28 were men and 23 were women (M:F ratio 1.2). All patients were symptomatic, and predominant presenting symptoms are TIA or stroke, Cranial Nerve involvement, and a pulsatile cervical or parapharyngeal mass. Aneurysms were divided into 3 types: Degenerative Aneurysm (DA) was diagnosed in 21 patients (40.3%), Mycotic (MA) in 6 (11.5%), and Pseudoaneurysm/Trauma in 8 (15.3%). Surgical intervention was performed in 50 patients (96.1%) and endovascular procedure in 2 (3.8%). Complications occurred in 8 patients (15.3%), and included residual neurologic deficit, myocardial infarction, and death.
Conclusions:
Although rare, ICA aneurysms should be considered in the differential diagnosis of a mass in the anterior triangle of the neck. Although recently endovascular therapy became a feasible option, open surgical repair is still the treatment of choice for most symptomatic patients. Additional randomized controlled trials studying ICAA is therefore necessary to confirm the conclusions presented here.
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