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Abstract

Introduction:

In this report, we aim to present a very rare case of internal carotid artery (ICA) aneurysm secondary to kinking and cystic medial degeneration.

Case report:

A 66-year-old female patient was admitted to our institution for multidetector computed tomography (MDCT) angiography of supra-aortic trunks. On admission, she complained of occasional dizziness; 2 months earlier ascending aorta reconstruction was done for aneurysmal disease. Color Doppler ultrasonography and MDCT arteriography revealed significant right ICA kinking associated with large aneurysm, 24.6 × 24.5 mm² in diameter. Aneurysm resection was done followed by ICA reconstruction by end-to-end anastomosis. Pathohistological findings of aneurysmal sac revealed cystical medial degeneration with inflammatory infiltrate mostly consisting of lymphocytes and fibrovascular proliferation.

Conclusion:

This is the first case that describes mutual contribution of cystic medial degeneration and ICA kinking in carotid aneurysm disease etiology successfully treated by aneurysm resection.

Keywords

internal carotid artery aneurysm cystic medial degeneration

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References

El-Sabrout

Cooley

. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg. 2000;31(4):702–712.

Miksic

Flis

Kosir

Pavlovic

Tetickovic

. Surgical aspects of fusiform and saccular extracranial carotid artery aneurysms. Cardiovasc Surg. 1997;5(2):190–195.

McCann

. Basic data related to peripheral artery aneurysms. Ann Vasc Surg. 1990;4(4):411–414.

Wiesenfarth

. Dissection, aortic. http://www.emedicine.com/emerg/topic28.htm. Accessed October 10, 2010.

Bahnson

Nelson

. Cystic medial necrosis as a cause of localized aortic aneurysms amenable to surgical treatment. Ann Surg. 1956;144(4):519–529.

Carlson

Lillehei

Edwards

. Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am J Cardiol. 1970;25(4):411–415.

Lau

Cheng

Lam

. Carotid artery aneurysm secondary to cystic medial necrosis. J R Coll Surg Edinb. 2001;46(3):173–175.

Alpagut

Ugurlucan

Kafali

. Aneurysm of the kinked extracranial internal carotid artery—case report and review of the literature. Acta Chir Belg. 2005;105(4):407–409.

Belov

Stepanenko

Bogopol'skaia

Kizyma

. Surgical treatment of aneurysm and kinking of the internal carotid artery. Angiol Sosud Khir. 2006;12(4):115–118.

10.

Bickerstaff

Pairolero

Hollier

. Thoracic aortic aneurysms: a population-based study. Surgery. 1982;92(6):1103–1108.

11.

Gravholt

Landin-Wilhelmsen

Stochholm

. Clinical and epidemiological description of aortic dissection in Turner’s syndrome. Cardiol Young. 2006;16(5):430–436.

12.

Ueda

Shimizu

Aeba

. Prognosis of Marfan and non-Marfan patients with cystic medial necrosis of the aorta. Jpn J Thorac Cardiovasc Surg. 1999;47(2):73–78.

13.

Marsalese

Moodie

Lytle

. Cystic medial necrosis of the aorta in patients with Marfan’s syndrome: surgical outcome and long-term follow-up. J Am Coll Cardiol. 1990;16(1):68–73.

14.

Painter

Herzer

Beven

O’Hara

. Extracranial carotid aneurysms: a report of six cases and a review of the literature. J Vasc Surg. 1985;2(2):312–318.

15.

Welling

Kakkasseril

Peschiera

. Pseudo-aneurysm of the cervical internal carotid artery secondary to blunt trauma. J Trauma. 1985;25(11):1108–1110.

16.

Mokri

Sundt

Jr Houser

. Spontaneous internal carotid dissection, hemicrania, and Horner’s syndrome. Arch Neurol. 1979;36(11):677–680.

17.

Smith

Munschauer

Diamond

Rivera

. Ruptured internal carotid aneurysm resulting from neurofibromatosis: treatment with intraluminal stent graft. J Vasc Surg. 2000;32(4):824–828.

18.

Bonnote

Krause

Fauton

Theron

Chauffert

Lorcer

. False aneurysm of the internal carotid artery in Bechet’s disease: successful combined endovascular treatment with stent and coils. Rheumatology (Oxford). 1999;38(6):576–577.

19.

Gupta

Dougherty

Hermman

Krajcer

. Endovascular repair of a giant carotid pseudoaneurysm with the use of Viabahn stent graft. Catheter Cardiovasc Interv. 2004;62(1):64–68.

20.

Ellis

Kennedy

Barros D’Sa

. Successful exclusion of a high internal carotid pseudoaneurysm using the Wallgraft endoprosthesis. Cardiovasc Intervent Radiol. 2002;25(1):68–69.

21.

Saatci

Cekirge

Ozturk

. Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results. AJNR Am J Neuroradiol. 2004;25(10):1742–1749.

22.

Mukherjee

Inahara

. Management of the tortuous internal carotid artery. Am J Surg. 1985;149(5):651–655.

23.

Koskas

Bahnini

Walden

Kieffer

. Stenotic coiling and kinking of the internal carotid artery. Ann Vasc Surg. 1993;7(6):30–40.

24.

Schechter

DS.

Dolichocarotid syndrome. Cerebral ischemia related to cervical carotid artery redundancy with kinking. Parts I and II. N Y State J Med. 1979;79:1391–1397 and 1542–1549.

25.

Desai

Toole

. Kinks, coils and carotids: a review. Stroke. 1975;6(6):649–653.

26.

Radak

Davidovic

Vukobratov

. Carotid artery aneurysms: Serbian multicentric study. Ann Vasc Surg. 2007;21(1):23–29.