Carotid Aneurysms, Extracranial

• • Rare

  • May occur anywhere along extracranial portion

Epidemiology

True Aneurysms

• • Caused by

  • -Atherosclerosis

    -Occasionally by cystic medial necrosis, Marfan syndrome, or fibromuscular dysplasia

False Aneurysms

• • Occur rarely after carotid endarterectomy

  • Occur as result of trauma, or infection (pharyngeal abscess)

Symptoms and Signs

• • Pulsatile neck mass

  • Dysphagia can occur from protrusion into oropharynx

  • Neck pain, radiating to jaw

  • 30% present with transient ischemic attacks

  • Rupture (more common with false aneurysms) into oropharynx, ear canal, soft tissues of neck

Imaging Findings

• • Duplex US: Initial test

  • Arteriography necessary to plan surgery

• • Duplex US will differentiate redundant carotid artery from aneurismal and identify occlusive disease

Rule Out

• • Coiled or redundant carotid artery, subclavian artery (can present as pulsatile neck mass)

• • Duplex US

  • Angiography prior to surgery

  • Consider CT if infection or traumatic

• • If accessible, resect and replace aneurysm with graft or vein

  • Endovascular stenting may be an option

  • False aneurysms should be repaired

  • Can ligate extensive aneurysm if back pressure > 65 mm Hg

  • -Can identify potential candidates with awake arteriography and balloon occlusion

Surgery

Indications

• • True or false aneurysm

Prognosis

• • Good if repairable

Preferences

• • El-Sabrout R et al. Extracranial carotid artery aneurysms: Texas Heart Institute experience. J Vasc Surg. 2000;31:702.

  • Rosset E et al. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg. 2000;31:713.