Carotid artery aneurysm: Evolution of management over two decades

Introduction: Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period. Methods: Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. Results: A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by neurological symptoms (n=6, 14%). Twenty two (52%) were atherosclerotic aneurysms, fifteen (36%) false aneurysms, and five (12%) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five patients underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 patients underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69%). Conclusions: Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.