Both true and false extracranial carotid artery aneurysms (ECAA) are a potential source of morbidity and mortality. While ECAA have historically been treated surgically, endovascular reconstruction with stenting is an emerging treatment option. The aim of our study was to report clinical/radiologic outcomes following endovascular repair of ECAAs.
Methods:
A comprehensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results:
A total of 68 case reports and case series, comprising 162 patients, were included. Most patients presented with at least one symptom or sign related to the ECAA (89.5%; N = 145/162). In 42.6% (N = 69/162) and 46.3% (N = 75/162) of the cases polytetrafluoroethylene covered and uncovered stents were deployed respectively. Immediate post-procedural imaging demonstrated complete aneurysm exclusion in 86.4% (N = 140/162) of the cases and minimal filling of the aneurysm sack in 10.5% (N = 17/162) of all cases. Perioperative adverse event rates were 3.1% for stroke, 1.2% for transient ischemic attack (TIA) and 4.3% for mortality. During a mean follow-up of 21.8months, there were additionally observed one stroke, two TIAs and three deaths. Overall 88.6 % of the patients (N = 117/132) remained asymptomatic, partially recovered or at least did not suffer from new neurologic deficits during follow up, with no signs of stenosis or occlusion of the carotid artery.
Conclusions:
Endovascular stenting for the treatment of ECAAs is feasible with acceptable short- and long-term clinical and radiologic outcomes. Prospective real-world studies are needed to further validate the safety and the long-term patency of endovascular repair.
LiZChangGYaoC, et al.Endovascular stenting of extracranial carotid artery aneurysm: a systematic review. Eur J Vasc Endovasc Surg. 2011;42(4):419–426.
5.
WellingRETahaAGoelT, et al.Extracranial carotid artery aneurysms. Surgery. 1983;93(2):319–323.
6.
McCollumCHWheelerWGNoonGPDeBakeyME. Aneurysms of the extracranial carotid artery. Twenty-one years’ experience. Am J Surg. 1979;137(2):196–200.
7.
AltunGPulathanZHemsinliD. True aneurysms of the extracranial carotid artery: an evaluation of two “giant aneurysms” and the current literature. J Korean Neurosurg Soc. 2018;61(2):282–286.
8.
HathcockJJ. Flow effects on coagulation and thrombosis. Arterioscler Thromb Vasc Biol. 2006;26(8):1729–1737.
9.
RhodesELStanleyJCHoffmanGLCronenwettJLFryWJ. Aneurysms of extracranial carotid arteries. Arch Surg. 1976;111(4):339–343.
10.
ShipleyAMWinslowNWalkerWW. Aneurysm in the cervical portion of the internal carotid artery: an analytical study of the cases recorded in the literature between August 1, 1925, and July 31, 1936 report of two new cases. Ann Surg. 1937;105(5):673–699.
11.
AngilettaDPulliRMarinazzoDFrotinoPMaiellaroLReginaG. Surgical and endovascular treatment of extracranial carotid artery aneurysms: early and long-term results of a single center. Ann Vasc Surg. 2014;28(3):659–664.
12.
AttigahNKulkensSZausigN, 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):127–133.
13.
ZhouWLinPHBushRL, et al.Carotid artery aneurysm: evolution of management over two decades. J Vasc Surg. 2006;43(3):493–496; discussion 497.
14.
LiberatiAAltmanDGTetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.
15.
AbeEGodaMTashimaANakanoTKuboTFujikiM. A case of spontaneous dissection of the extracranial internal carotid artery. Neurosurg Q. 2015;25(2):149–153.
16.
ArgaliousMGottliebATetzlaffJ. Anesthesia for endovascular stent repair of a traumatic pseudoaneurysm of the extracranial internal carotid artery. J Clin Anesth. 2002;14(1):64–65.
17.
Baptista-SincosAPWSimplicioABSincosIR, et al.Flow-diverting stent in the treatment of cervical carotid dissection and pseudoaneurysm: review of literature and case report. Ann Vasc Surg. 2018;46:372–379.
18.
BenndorfGWellnhoferESchneiderGH. Doubled stenting for effective occlusion of a dissecting carotid artery aneurysm. Interv Neuroradiol. 2000;6(4):343–348.
19.
BergeronPKhanoyanPMeunierJPGrazianiJNGayJ. Long-term results of endovascular exclusion of extracranial internal carotid artery aneurysms and dissecting aneurysm. J Interv Cardiol. 2004;17(4):245–252.
ChanAWYadavJSKriegerDAbou-CheblA. Endovascular repair of carotid artery aneurysm with Jostent covered stent: initial experience and one-year result. Catheter Cardiovasc Interv. 2004;63(1):15–20.
22.
ChenPREdwardsNJSanzgiriADayAL. Efficacy of a self-expandable porous stent as the sole curative treatment for extracranial carotid pseudoaneurysms. World Neurosurg. 2016;88:333–341.
23.
ClausIJacobsBDe GrooteLWillaertW. Endovascular repair of an extracranial carotid artery aneurysm complicated by late stent thrombosis. Acta Chir Belg. 2020;120(1):42–46.
24.
CohenJERajzGValarezoJUmanskyFSpektorS. Endovascular stenting for the treatment of post-traumatic aneurysms of the extracranial internal carotid artery. Neurol Res. 2004;26(6):662–665.
25.
DeguchiJNagasawaSTanakaHSuzukiSHirotaYOhtaT. Spontaneous dissecting pseudoaneurysm of the extracranial internal carotid artery: endovascular treatment with a palmaz stent. Interv Neuroradiol. 1998;4(suppl 1):101–104.
26.
DingDStarkeRMMoriartyMBrewS. Telescoping dual covered stent graft construct for endovascular treatment of a giant extracranial carotid artery pseudoaneurysm. J Neurosci Rural Pract. 2016;7(suppl 1):S103–S105.
27.
ErgunOCeltikciPCanyigitMBirgiEHidirogluMHekimogluB. Covered stent-graft treatment of a postoperative common carotid artery pseudoaneurysm. Pol J Radiol. 2014;79:333–336.
28.
FelberSHenkesHWeberWMiloslavskiEBrewSKuhneD. Treatment of extracranial and intracranial aneurysms and arteriovenous fistulae using stent grafts. Neurosurgery. 2004;55(3):631–638; discussion 638-639.
29.
FischerBPalkovicSWassmannHHeindelWKramerSC. Endovascular management of tandem extracranial internal carotid artery aneurysms with a covered stent. J Endovasc Ther. 2004;11(6):739–741.
30.
FujiiHShojimaMMiyataTNambaKNemotoS. Spontaneous thrombosis of an extracranial giant internal carotid artery aneurysm after carotid artery stenting for concomitant carotid artery stenosis. J Neuroendovascular Ther. 2008;2(2):149–153.
31.
GiorgianniAPellegrinoCMicieliC, et al.Endovascular treatment of extracranial internal carotid pseudoaneurysm: description of three cases. Surg J (N Y). 2016;2(2):e15–e18.
32.
Goes JuniorAMJehaSA. Stent graft-in-stent graft as a rescue technique for endovascular treatment of giant extracranial internal carotid aneurysm. Case Rep Surg. 2016;2016:2656421.
33.
GolarzSRGableD. Use of a Viabahn stent for repair of a common carotid artery pseudoaneurysm and dissection. Ann Vasc Surg. 2010;24(4):550.e511-553.
34.
GuptaRThomasAJMasihAHorowitzMB. Treatment of extracranial carotid artery pseudoaneurysms with stent grafts: case series. J Neuroimaging. 2008;18(2):180–183.
35.
HamasakiOIkawaFHidakaTKurokawaYYonezawaU. Extracranial internal carotid artery pseudoaneurysm associated with neurofibromatosis type 1 treated with endovascular stenting and coil embolization. Vasc Endovascular Surg. 2014;48(2):176–179.
36.
HamidianJATanTWCoulterAHDoucetLDZhangWW. Endovascular repair of symptomatic carotid artery aneurysm with covered stent: a case report and literature review. SAGE Open Med Case Rep. 2015;3:2050313X15572502.
37.
HanDKTadrosROChungCPatelAMarinMLFariesPL. Endovascular treatment of 2 synchronous extracranial carotid artery aneurysms using stent-assisted coil embolization and double bare-metal stenting. Vasc Endovascular Surg. 2016;50(2):102–106.
38.
HorowitzMBMillerGIIIMeyerYCarstensGIIIPurdyPD. Use of intravascular stents in the treatment of internal carotid and extracranial vertebral artery pseudoaneurysms. AJNR Am J Neuroradiol. 1996;17(4):693–696.
39.
IsakaFHashimotoKAkiyamaYOkamotoSIKomuroTNittaT. Giant cervical carotid artery pseudoaneurysm treated with a covered stent: two case reports. J Neuroendovascular Ther. 2009;3(2):124–130.
KabbaschCBangardCLiebigTMajdPMpotsarisAFaymonvilleA. The dual layer Casper micromesh stent: taking advantage of flow-diverting capabilities for the treatment of extracranial aneurysms and pseudoaneurysms. Cardiovasc Intervent Radiol. 2016;39(3):472–476.
42.
KandasamyJNahserHJavadpourM. Dysphagia and hoarse voice: an unusual cause. Br J Neurosurg. 2008;22(2):303–304.
43.
KatsevmanGABracaJA3rdWelchKCAshleyWWJr. Delayed presentation of an extracranial internal carotid artery pseudoaneurysm and massive epistaxis secondary to a nasal foreign body: case report and review of the literature. World Neurosurg. 2016;92:585.e513-585.e519.
44.
KleinGESzolarDHRaithJFruhwirthHPascherOHauseggerKA. Posttraumatic extracranial aneurysm of the internal carotid artery: combined endovascular treatment with coils and stents. AJNR Am J Neuroradiol. 1997;18(7):1261–1264.
45.
MacinaASVidjakVErdelezLSuknaicSGasparovSNovacicK. Open surgical and endovascular treatment of extracranial internal carotid artery aneurysms. Perspect Vasc Surg Endovasc Ther. 2009;21(3):181–185.
46.
MarasDLioupisCMagoufisGTsamopoulosNMoulakakisKAndrikopoulosV. Covered stent-graft treatment of traumatic internal carotid artery pseudoaneurysms: a review. Cardiovasc Intervent Radiol. 2006;29(6):958–968.
47.
MaseMBannoTYamadaKKatanoH. Endovascular stent placement for multiple aneurysms of the extracranial internal carotid artery: technical case report. Neurosurgery. 1995;37(4):832–835.
48.
MathewsJYeongCCReddyKTKentSE. Bilateral aneurysms of the extracranial internal carotid artery presenting as vocal fold palsy. J Laryngol Otol. 2001;115(8):663–665.
49.
MiyachiSIshiguchiTTaniguchiKMiyazakiMMaedaK. Endovascular stenting of a traumatic dissecting aneurysm of the extracranial internal carotid artery—case report. Neurol Med Chir (Tokyo). 1997;37(3):270–274.
50.
MukherjeePHuilgolRGrahamAFaganP. Open and endovascular repair of aneurysms affecting the distal extracranial internal carotid artery: case series. J Laryngol Otol. 2016;130(suppl 4):S29–S34.
51.
NiLPuZZengR, et al.Endovascular stenting for extracranial carotid artery aneurysms: experiences and mid-term results. Medicine (Baltimore). 2016;95(46):e5442.
52.
OngJLJalaludinS. Traumatic pseudoaneurysm of right extracranial internal carotid artery: a rare entity and recent advancement of treatment with minimally invasive technique. Malays J Med Sci. 2016;23(2):78–81.
53.
PanYHLinYDingSH, et al.Endovascular treatment of the extracranial carotid pseudoaneurysms resulting from stab penetrating injury using overlapping bare stents. Vasc Endovascular Surg. 2014;48(4):337–341.
54.
PeelingLFiorellaD. Balloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience. J Neurointerv Surg. 2014;6(2):129–133.
55.
PeetersAGoffettePDorbanSSindicCJCosnardG. An old dissecting aneurysm of the internal carotid artery presenting as acute stroke. Acta Neurol Belg. 2003;103(3):179–182.
56.
PenezicALjubesicLGreguricTZurakKVagicDZadravecD. An internal carotid artery pseudoaneurysm with neck hematoma: a rare cause of a life-threatening neck mass mimicking an abscess. Auris Nasus Larynx. 2019;46(6):912–916.
57.
PulliRDorigoWPratesiGFargionAPratesiC. Single-center experience on endovascular repair of noninfected extracranial internal carotid artery pseudoaneurysms. Ann Vasc Surg. 2013;27(5):672.e613-677.
RedekopGMarottaTWeillA. Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg. 2001;95(3):412–419.
60.
Rivera-ChavarriaIJAlvarado-MarinJC. Endovascular repair for an extracranial internal carotid aneurysm with cervical access: a case report. Int J Surg Case Rep. 2016;19:14–16.
61.
RobijnSMMWelleweerdJCLoRTHMollFLde BorstGJ. Treatment of an extracranial internal carotid artery aneurysm with a flow-diverting stent. J Vasc Surg Cases. 2015;1(2):191–193.
62.
SaketRRRazaviMKSzeDYFrisoliJKKeeSTDakeMD. Stent-graft treatment of extracranial carotid and vertebral arterial lesions. J Vasc Interv Radiol. 2004;15(10):1151–1156.
63.
SeungWBKimJWParkYS. Stent-assisted coil trapping in a manual internal carotid artery compression test for the treatment of a fusiform dissecting aneurysm. J Korean Neurosurg Soc. 2012;51(5):296–300.
64.
SewardCJDumontTMLevyEI. Endovascular therapy of extracranial carotid artery pseudoaneurysms: case series and literature review. J Neurointerv Surg. 2015;7(9):682–689.
65.
SiablisDKarnabatidisDKatsanosKMastronikolisNZabakisPKraniotisP. Extracranial internal carotid artery aneurysms: report of a ruptured case and review of the literature. Cardiovasc Intervent Radiol. 2004;27(4):397–401.
66.
SimionatoFRighiCMelissanoGRolliAChiesaRScottiG. Stent-graft treatment of a common carotid artery pseudoaneurysm. J Endovasc Ther. 2000;7(2):136–140.
67.
SongGJiaoLChenYWangYMaYLingF. Management of extracranial carotid artery aneurysm: a report of four cases. Exp Ther Med. 2015;10(3):1029–1032.
68.
SultanSElkadyRBarrettNHynesN. Endovascular management of saccular extracranial internal carotid artery aneurysm using transcervical carotid approach and flow reversal. J Vasc Surg Cases Innov Tech. 2019;5(3):273–277.
69.
SzopinskiPCiostekPKielarMMyrchaPPlebanENoszczykW. A series of 15 patients with extracranial carotid artery aneurysms: surgical and endovascular treatment. Eur J Vasc Endovasc Surg. 2005;29(3):256–261.
70.
TahaMMNakaharaIHigashiTIwamuroYWatanabeYTakiW. Interventional neuroradiological techniques for the treatment of aneurysms of the supra-aortic extracranial arteries. Neurol Med Chir (Tokyo). 2010;50(4):275–280.
71.
TsengARamaiahVRodriguez-LopezJA, et al.Emergent endovascular treatment of a spontaneous internal carotid artery dissection with pseudoaneurysm. J Endovasc Ther. 2003;10(3):643–646.
72.
TsolakiESalviatoERoccaTBracciniLGaleottiRMascoliF. Heparin surface stent-graft for the treatment of a carotid pseudoaneurysm. Ann Vasc Surg. 2010;24(7):952.e959-952.e912.
73.
TsujiKFukawaNNakagawaNYabuuchiTNakanoNKatoA. Overlapped stenting for treatment of an extracranial carotid artery aneurysm. NMC Case Rep J. 2015;2(3):93–96.
74.
VajpayeeAGoyalGKantR. Conjoined stent technique for radiation induced long segment carotid stenosis and pseudoaneurysm. Neurointervention. 2014;9(1):50–52.
75.
Vazquez RodriguezCLemaireVRenardFDe KeuleneerR. Primary stenting for the acute treatment of carotid artery dissection. Eur J Vasc Endovasc Surg. 2005;29(4):350–352.
76.
WangASantarelliJStiefelMF. Pipeline embolization device as primary treatment for cervical internal carotid artery pseudoaneurysms. Surg Neurol Int. 2017;8:3.
77.
WelleweerdJCde BorstGJde GrootDvan HerwaardenJALoRTMollFL. Bare metal stents for treatment of extracranial internal carotid artery aneurysms: long-term results. J Endovasc Ther. 2015;22(1):130–134.
78.
WyersMCPowellRJ. Management of carotid injuries in a hostile neck using endovascular grafts. J Vascu Surg. 2004;39(6):1335–1339.
79.
YamamotoSAkiokaNKashiwazakiDKohMKuwayamaNKurodaS. Surgical and endovascular treatments of extracranial carotid artery aneurysms-report of six cases. J Stroke Cerebrovasc Dis. 2017;26(7):1481–1486.
80.
YiACPalmerELuhGYJacobsonJPSmithDC. Endovascular treatment of carotid and vertebral pseudoaneurysms with covered stents. AJNR Am J Neuroradiol. 2008;29(5):983–987.
81.
TexakalidisPKarasavvidisTGiannopoulosS, et al.Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review [published online ahead of print March 22, 2019]. Neurosurg Rev. 2019.
82.
MohanIVStephenMS. Peripheral arterial aneurysms: open or endovascular surgery?Prog Cardiovasc Dis. 2013;56(1):36–56.
83.
NordonIMHinchliffeRJHoltPJLoftusIMThompsonMM. Review of current theories for abdominal aortic aneurysm pathogenesis. Vascular. 2009;17(5):253–263.
84.
NormanPEPowellJT. Site specificity of aneurysmal disease. Circulation. 2010;121(4):560–568.
85.
TexakalidisPSweidAMouchtourisN, et al.Aneurysm formation, growth, and rupture: the biology and physics of cerebral aneurysms. World Neurosurg. 2019;130:277–284.
86.
SrivastavaSDEagletonMJO’HaraPKashyapVSSaracTClairD. Surgical repair of carotid artery aneurysms: a 10-year, single-center experience. Ann Vasc Surg. 2010;24(1):100–105.
87.
WelleweerdJCMollFLde BorstGJ. Technical options for the treatment of extracranial carotid aneurysms. Expert Rev Cardiovasc Ther. 2012;10(7):925–931.
88.
PulliRDorigoWAlessi InnocentiAPratesiGFargionAPratesiC. A 20-year experience with surgical management of true and false internal carotid artery aneurysms. Eur J Vasc Endovasc Surg. 2013;45(1):1–6.
89.
TouzeERandouxBMearyEArquizanCMederJFMasJL. Aneurysmal forms of cervical artery dissection: associated factors and outcome. Stroke. 2001;32(2):418–423.
90.
NiLWengHPuZ, et al.Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms. J Vasc Surg. 2018;67(5):1429–1437.
