Skip to main content
SpringerLink
Log in

Extracranial Carotid Artery Aneurysms

  • Chapter
  • First Online:
Carotid Artery Disease

  • 801 Accesses

Abstract

Extracranial carotid artery (ECCAs) aneurysms are rare, accounting for up to less than 1% of all arterial aneurysms. The aneurysms are broadly classified as true aneurysms mostly due to atherosclerotic disease or false aneurysms due to secondary causes including dissection, infection, or local trauma. The segment of the carotid artery around the bifurcation is most commonly affected. Most symptomatic patients present with strokes or local mass effect. Despite the rarity, treatment may be indicated in this cohort because of the higher risk of embolic or occlusive strokes. Surgical resection of the aneurysm and bypass using a graft has been the traditional treatment methods. Other surgical treatment options include carotid ligation, aneurysmorrhaphy, or high flow bypass procedures. Recently, endovascular treatment has evolved as a minimally invasive approach with a comparable outcomes to surgery. Use of covered stents has been the most commonly described endovascular option; however, recent successful reports of using layered bare metal stents and flow diverters are encouraging. A definite guideline for treatment is lacking owing to the rarity of the lesion and scarcity of research involved in this disease. However, available evidence suggests that surgery and endovascular management may be better suited for true and false aneurysms, respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Faggioli GL, Freyrie A, Stella A, Pedrini L, Gargiulo M, Tarantini S, et al. Extracranial internal carotid artery aneurysms: results of a surgical series with long-term follow-up. J Vasc Surg. 1996;23(4):587–94; discussion 94–5.

    Article  CAS  PubMed  Google Scholar 

  2. McCollum CH, Wheeler WG, Noon GP, DeBakey ME. Aneurysms of the extracranial carotid artery. Twenty-one years’ experience. Am J Surg. 1979;137(2):196–200.

    Article  CAS  PubMed  Google Scholar 

  3. Moreau P, Albat B, Thevenet A. Surgical treatment of extracranial internal carotid artery aneurysm. Ann Vasc Surg. 1994;8(5):409–16.

    Article  CAS  PubMed  Google Scholar 

  4. van Sambeek MR, Segeren CM, van Dijk LC, van Essen JA, Dippel DW, van Urk H. Endovascular repair of an extracranial internal carotid artery aneurysm complicated by heparin-induced thrombocytopenia and thrombosis. J Endovasc Ther. 2000;7(5):353–8.

    Article  PubMed  Google Scholar 

  5. Houser OW, Baker HL Jr. Fibromuscular dysplasia and other uncommon diseases of the cervical carotid artery: angiographic aspects. Am J Roentgenol Radium Therapy, Nucl Med. 1968;104(1):201–12.

    Article  CAS  Google Scholar 

  6. Attigah N, Kulkens S, Zausig N, Hansmann J, Ringleb P, Hakimi M, et al. Surgical therapy of extracranial carotid artery aneurysms: long-term results over a 24-year period. Eur J Vasc Endovasc Surg. 2009;37(2):127–33.

    Article  CAS  PubMed  Google Scholar 

  7. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  8. Zhou W, Lin PH, Bush RL, Peden E, Guerrero MA, Terramani T, et al. Carotid artery aneurysm: evolution of management over two decades. J Vasc Surg. 2006;43(3):493–6; discussion 7.

    Article  PubMed  Google Scholar 

  9. Fankhauser GT, Stone WM, Fowl RJ, O’Donnell ME, Bower TC, Meyer FB, et al. Surgical and medical management of extracranial carotid artery aneurysms. J Vasc Surg. 2015;61(2):389–93.

    Article  PubMed  Google Scholar 

  10. Welleweerd JC, den Ruijter HM, Nelissen BG, Bots ML, Kappelle LJ, Rinkel GJ, et al. Management of extracranial carotid artery aneurysm. Eur J Vasc Endovasc Surg. 2015;50(2):141–7.

    Article  CAS  PubMed  Google Scholar 

  11. Welleweerd JC, Nelissen BG, Koole D, de Vries JP, Moll FL, Pasterkamp G, et al. Histological analysis of extracranial carotid artery aneurysms. PLoS One. 2015;10(1):e0117915.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Longo GM, Kibbe MR. Aneurysms of the carotid artery. Semin Vasc Surg. 2005;18(4):178–83.

    Article  PubMed  Google Scholar 

  13. Rittenhouse EA, Radke HM, Sumner DS. Carotid artery aneurysm. Review of the literature and report of a case with rupture into the oropharynx. Arch Surg. 1972;105(5):786–9.

    Article  CAS  PubMed  Google Scholar 

  14. Pirvu A, Bouchet C, Garibotti FM, Haupert S, Sessa C. Mycotic aneurysm of the internal carotid artery. Ann Vasc Surg. 2013;27(6):826–30.

    Article  PubMed  Google Scholar 

  15. Branch CL Jr, Davis CH Jr. False aneurysm complicating carotid endarterectomy. Neurosurgery. 1986;19(3):421–5.

    Article  PubMed  Google Scholar 

  16. Rahme RJ, Aoun SG, McClendon J Jr, El Ahmadieh TY, Bendok BR. Spontaneous cervical and cerebral arterial dissections: diagnosis and management. Neuroimaging Clin N Am. 2013;23(4):661–71.

    Article  PubMed  Google Scholar 

  17. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344(12):898–906.

    Article  CAS  PubMed  Google Scholar 

  18. Ellens DJ, Hurley MC, Surdel D, Shaibani A, Pelzer H, Bendok BR. Radiotherapy-induced common carotid pseudoaneurysm presenting with initially occult upper airway hemorrhage and successfully treated by endovascular stent graft. Am J Otolaryngol. 2010;31(3):195–8.

    Article  PubMed  Google Scholar 

  19. Lam JW, Chan JY, Lui WM, Ho WK, Lee R, Tsang RK. Management of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma patients. Laryngoscope. 2014;124(10):2292–6.

    Article  PubMed  Google Scholar 

  20. Mokri B, Piepgras DG, Sundt TM Jr, Pearson BW. Extracranial internal carotid artery aneurysms. Mayo Clin Proc. 1982;57(5):310–21.

    CAS  PubMed  Google Scholar 

  21. Zhang Q, Duan ZQ, Xin SJ, Wang XW, Dong YT. Management of extracranial carotid artery aneurysms: 17 years’ experience. Eur J Vasc Endovasc Surg. 1999;18(2):162–5.

    CAS  PubMed  Google Scholar 

  22. Nordanstig J, Gelin J, Jensen N, Osterberg K, Stromberg S. National experience with extracranial carotid artery aneurysms: epidemiology, surgical treatment strategy, and treatment outcome. Ann Vasc Surg. 2014;28(4):882–6.

    Article  PubMed  Google Scholar 

  23. Winslow N. Extracranial aneurysm of the internal carotid artery: history and analysis of the cases registered up to Aug. 1, 1925. Arch Surg. 1926;13(5):689–729.

    Article  Google Scholar 

  24. Brock RC. Astley Cooper and carotid artery ligation. Guys Hosp Rep. 1968;117(3):219–24.

    CAS  PubMed  Google Scholar 

  25. Welling RE, Taha A, Goel T, Cranley J, Krause R, Hafner C, et al. Extracranial carotid artery aneurysms. Surgery. 1983;93(2):319–23.

    CAS  PubMed  Google Scholar 

  26. Radak D, Davidovic L, Tanaskovic S, Banzic I, Matic P, Babic S, et al. A tailored approach to operative repair of extracranial carotid aneurysms based on anatomic types and kinks. Am J Surg. 2014;208(2):235–42.

    Article  PubMed  Google Scholar 

  27. Davidovic L, Kostic D, Maksimovic Z, Markovic D, Vasic D, Markovic M, et al. Carotid artery aneurysms. Vascular. 2004;12(3):166–70.

    Article  PubMed  Google Scholar 

  28. El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg. 2000;31(4):702–12.

    Article  CAS  PubMed  Google Scholar 

  29. Radak D, Davidovic L, Vukobratov V, Ilijevski N, Kostic D, Maksimovic Z, et al. Carotid artery aneurysms: Serbian multicentric study. Ann Vasc Surg. 2007;21(1):23–9.

    Article  PubMed  Google Scholar 

  30. Angiletta D, Pulli R, Marinazzo D, Frotino P, Maiellaro L, Regina G. Surgical and endovascular treatment of extracranial carotid artery aneurysms: early and long-term results of a single center. Ann Vasc Surg. 2014;28(3):659–64.

    Article  PubMed  Google Scholar 

  31. Coldwell DM, Novak Z, Ryu RK, Brega KE, Biffl WL, Offner PJ, et al. Treatment of posttraumatic internal carotid arterial pseudoaneurysms with endovascular stents. J Trauma. 2000;48(3):470–2.

    Article  CAS  PubMed  Google Scholar 

  32. Schievink WI, Piepgras DG, McCaffrey TV, Mokri B. Surgical treatment of extracranial internal carotid artery dissecting aneurysms. Neurosurgery. 1994;35(5):809–15; discussion 15–6.

    Article  CAS  PubMed  Google Scholar 

  33. Sattur MG, Welz ME, Bendok BR, Miller JW. Balloon occlusion testing to assess retinal collateral and predict visual outcomes in the management of a fusiform intraorbital ophthalmic artery aneurysm: technical note and literature review. Oper Neurosurg (Hagerstown). 2019;16(2):60–6.

    Article  Google Scholar 

  34. Shaibani A, Khawar S, Bendok B, Walker M, Russell EJ, Batjer HH. Temporary balloon occlusion to test adequacy of collateral flow to the retina and tolerance for endovascular aneurysmal coiling. AJNR Am J Neuroradiol. 2004;25(8):1384–6.

    PubMed  Google Scholar 

  35. Surdell DL, Hage ZA, Eddleman CS, Gupta DK, Bendok BR, Batjer HH. Revascularization for complex intracranial aneurysms. Neurosurg Focus. 2008;24(2):E21.

    Article  PubMed  Google Scholar 

  36. Adel JG, Parkinson RJ, Bendok BR, Dauber MH, Batjer HH. Balloon test occlusion of the internal carotid artery. Contemp Neurosurg. 2005;27(9):1–6.

    Article  Google Scholar 

  37. Fisch UP, Oldring DJ, Senning A. Surgical therapy of internal carotid artery lesions of the skull base and temporal bone. Otolaryngol Head Neck Surg. (1979. 1980;88(5):548–54.

    Article  CAS  PubMed  Google Scholar 

  38. Tecle NEE, Zammar SG, Hamade YJ, Ahmadieh TYE, Aoun RJN, Nanney AD, et al. Use of a harvested radial artery graft with preservation of the vena comitantes to reduce spasm risk and improve graft patency for extracranial to intracranial bypass: technical note. Clin Neurol Neurosurg. 2016;142:65–71.

    Article  PubMed  Google Scholar 

  39. Ni L, Pu Z, Zeng R, Zhang R, Zheng YH, Ye W, et al. Endovascular stenting for extracranial carotid artery aneurysms: experiences and mid-term results. Medicine (Baltimore). 2016;95(46):e5442.

    Article  Google Scholar 

  40. Li Z, Chang G, Yao C, Guo L, Liu Y, Wang M, et al. Endovascular stenting of extracranial carotid artery aneurysm: a systematic review. Eur J Vasc Endovasc Surg. 2011;42(4):419–26.

    Article  CAS  PubMed  Google Scholar 

  41. Welleweerd JC, de Borst GJ, de Groot D, van Herwaarden JA, Lo RT, Moll FL. Bare metal stents for treatment of extracranial internal carotid artery aneurysms: long-term results. J Endovasc Ther. 2015;22(1):130–4.

    Article  PubMed  Google Scholar 

  42. Chalouhi N, Satti SR, Tjoumakaris S, Dumont AS, Gonzalez LF, Rosenwasser R, et al. Delayed migration of a pipeline embolization device. Neurosurgery. 2013;72(2 Suppl Operative):ons229–34; discussion ons34.

    PubMed  Google Scholar 

  43. Rahal JP, Dandamudi VS, Heller RS, Safain MG, Malek AM. Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms. J Clin Neurosci. 2014;21(6):1024–8.

    Article  PubMed  Google Scholar 

  44. Chen PR, Edwards NJ, Sanzgiri A, Day AL. Efficacy of a self-expandable porous stent as the sole curative treatment for extracranial carotid pseudoaneurysms. World Neurosurg. 2016;88:333–41.

    Article  PubMed  Google Scholar 

  45. Sczudlo EF, Benavides-Baron C, Ho JT, Teitelbaum GP. Pipeline Embolization Device for the treatment of cervical carotid and vertebral dissecting aneurysms. J Vasc Surg. 2016;63(5):1371–4.

    Article  PubMed  Google Scholar 

  46. Wang A, Santarelli J, Stiefel MF. Pipeline embolization device as primary treatment for cervical internal carotid artery pseudoaneurysms. Surg Neurol Int. 2017;8:3.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Baptista-Sincos APW, Simplicio AB, Sincos IR, Leaderman A, Neto FS, Moraes A, et al. Flow-diverting stent in the treatment of cervical carotid dissection and pseudoaneurysm: review of literature and case report. Ann Vasc Surg. 2018;46:372–9.

    Article  PubMed  Google Scholar 

  48. Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, et al. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 2011;68(4):856–66; discussion 66.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Neurovascular and Skullbase Program, Precision Neuro-therapeutics Innovation Lab, Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ, USA

    Devi P. Patra, Matthew E. Welz, Chandan Krishna, Karl R. Abi-Aad & Jamal McClendon Jr

  2. Department of Neurological Surgery, Neurovascular and Skullbase Program, Mayo Clinic, Phoenix, AZ, USA

    Ali Turkmani & Lynda M. Christel

  3. Department of Neurological Surgery, Neurovascular and Skullbase Program, Department of Otolaryngology, Precision Neuro-therapeutics Innovation Lab, Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, AZ, USA

    Bernard R. Bendok

Authors
  1. Devi P. Patra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew E. Welz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chandan Krishna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Karl R. Abi-Aad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jamal McClendon Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Turkmani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lynda M. Christel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernard R. Bendok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernard R. Bendok .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Min S. Park

  2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    M. Yashar S. Kalani

  3. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Adam de Havenon

  4. Department of Radiology, University of Utah, Salt Lake City, UT, USA

    J. Scott McNally

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Patra, D.P. et al. (2020). Extracranial Carotid Artery Aneurysms. In: Park, M., Kalani, M., de Havenon, A., McNally, J. (eds) Carotid Artery Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-41138-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-41138-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41137-4

  • Online ISBN: 978-3-030-41138-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation