Extracranial Carotid Artery Aneurysms
What is an extracranial carotid artery aneurysm?
An aneurysm is a bulging or ballooning in the wall of a blood vessel. It is caused when a portion of the artery wall weakens. Like a balloon, as the aneurysm expands, the artery wall grows progressively thinner, increasing the likelihood that the aneurysm will burst.
Peripheral aneurysms affect the arteries other than the aorta, such as the carotid artery in your neck. An extracranial carotid artery aneurysm is located in the portion of the carotid artery that is in your neck.
What are the treatment options for carotid artery aneurysms?
The goals of treatment are to reduce symptoms and reduce the risk of complications. Symptoms for carotid artery aneurysms may include transient ischemic attacks (TIAs) or stroke. In addition, carotid artery aneurysms may form clots that block blood flow to your brain. If this occurs, or in order to prevent this from occurring, treatment may be warranted.
Other symptoms can occur secondary to pressure of the aneurysm on surrounding structures such as veins and nerves. These symptoms can vary, depending upon what is compressed, but may include facial swelling, hoarseness or difficulty swallowing. Rarely, carotid artery aneurysms can rupture, or burst, which is a life-threatening problem.
Each patient will be evaluated and treatment will be individualized for the patient’s circumstances. Before choosing any treatment, it is important to discuss the potential benefits, risks and side effects with your health care provider. You will receive specific guidelines to help you prepare for your procedure, as well as specific instructions to help your recovery.
If the aneurysm is small and not causing any symptoms, your physician may recommend “watchful waiting.” By closely monitoring your condition with ultrasound, CT or MRI scans every six to 12 months, the aneurysm will be watched for signs of changes.
If you have high blood pressure, your physician may prescribe blood pressure medication to lower your overall blood pressure and the pressure on the weakened area of the aneurysm. Additionally your physician may prescribe a statin (or cholesterol-lowering medication) to maintain the health of your blood vessels.
Thrombolysis may be used to eliminate clots that are blocking blood flow. Thrombolytic therapy uses drugs designed to dissolve clots and restore normal blood flow. Your physician will inject a clot-dissolving medication into a blood vessel. A catheter (a long, thin tube) may also be used to deliver the medication or to break up the clot.
Treatment option #1: surgical repair
The mainstay of treatment of extracranial carotid artery aneurysms is surgical repair. The surgical repair entails the resection of that portion of the carotid artery that is involved with the aneurysm. A bypass is then performed from the normal artery below the aneurysm to the normal artery above the aneurysm. The bypass may be performed with a variety of different conduits including a piece of vein taken from the leg, a piece of artery taken from another spot in your body, or a prosthetic graft made out of Gortex or polyester. The type of bypass material used will be determined by your surgeon. Learn more about surgical repair of carotid artery aneurysm.
Treatment option #2: endovascular stent grafting
Your surgeon may consider a newer procedure called an endovascular, or stent-graft, repair. Endovascular means that surgery is performed inside your artery using thin, long tubes called catheters. You may be eligible for endovascular stent grafting depending on the size of the aneurysm and its location relative to other branches of the carotid artery.
Your surgeon will enter through a puncture in one of the arteries in your groin, using catheters to guide and deliver a stent-graft through the blood vessels to the site of the aneurysm. X-ray guidance is used to position a graft made of artificial material to the area of the aneurysm. The graft is then expanded inside the artery and held in place with metallic hooks rather than sutures.
What are typical outcomes for aneurysm repair?
There are no large series documenting outcomes from carotid artery aneurysm repair. We have a larger experience with open aneurysm repair, and the outcomes are similar to that of carotid endarterectomy. The most concerning risk is peri-operative stroke, which occurs in less than 4 percent of operations. Other risks include injury to adjacent structures, such as nerves. Stent-graft repair is performed less frequently, but has an emerging success rate similar to that of carotid artery stenting and carotid endarterectomy.