Management of Extracranial Carotid Artery Aneurysms

Extracranial carotid artery aneurysms, though accounting for fewer than 1 % of all peripheral aneurysms, pose significant risks of stroke, rupture and thromboembolic events. They are categorised into true aneurysms, involving all three arterial wall layers, and pseudoaneurysms, where blood collects between vessel layers or in the surrounding tissue. Management strategies balance the risks of intervention against natural history. Traditionally, open surgery—entailing aneurysm excision and interposition grafting or bypass—has been the gold standard, particularly for complex or infected lesions. More recently, endovascular techniques have gained favour. Covered stents, bare-metal stents with adjunctive coiling and flow-diverting devices allow exclusion of the aneurysm sac with reduced procedural trauma. Patient selection hinges on aneurysm morphology, location (especially lesions at the skull base), comorbidities and surgical access. Hybrid approaches, combining open and endovascular methods, offer tailored solutions for anatomically challenging cases. Lifelong imaging surveillance and antithrombotic therapy are integral to detecting restenosis or endoleak and maintaining patency.

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Management of Extracranial Carotid Artery Aneurysms publication trend

The graph below shows the total number of articles in management of extracranial carotid artery aneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Aneurysm: Localised dilation of an artery exceeding 150 % of its normal diameter due to vessel-wall weakness.

Pseudoaneurysm: Haematoma communicating with the arterial lumen but contained by adventitia or surrounding tissue rather than all vessel wall layers.

Stent graft: A metallic scaffold covered by a synthetic membrane used to exclude an aneurysm sac while maintaining luminal flow.

Digital subtraction angiography (DSA): Imaging technique that subtracts pre-contrast from contrast-enhanced images to visualise vascular structures.

Transcervical approach: Surgical exposure of the carotid artery via an incision in the neck to access distal or skull-base lesions without skull-base osteotomy.

References

1. Endovascular stenting for extracranial carotid artery aneurysms. Medicine (2016).
2. Successful treatment of iatrogenic internal carotid artery pseudoaneurysm following carotid endarterectomy with thrombin injection: a case report. Journal of Medical Case Reports (2024).
3. Clinical Analysis of Interventional Therapy for Eight Cases of Extracranial ICA Aneurysm. Pakistan Journal of Medical Sciences (2021).
4. Transcervical approach to distal extracranial internal carotid aneurysm. Journal of Vascular Surgery Cases and Innovative Techniques (2024).