Case study

Case

16 years male presented with complaints of dizziness associated with transient loss of vision ? in the right eye over the past one month

Diagnosis ?

History ?

Any neurological deficit

Trauma

Any surgery

Fever, joint pain ?

Examination ?

Swelling

Pulsatile mass

Oral cavity

Carotid bruit

Horner’s syndrome

Complication ?

Thromboembolism

Neurological complications

Rupture

Management ?

Surgical reconstruction

Endovascular treatment

Complication ?

Thrombosis

Endoleak

Perforation

Migration

Infection

Dissection of artery

Carotid Artery Aneurysm

Introduction

Aneurysm of extracranial carotid artery (ECAA) is an uncommon but important clinical entity

Incidence of intracranial carotid artery aneurysm (0.8 – 18 %) and ECAA is 1- 1.5 %

ECAA is less than 1 % of all carotid pathologies

Definition

The accepted difinition of most arterial aneurysm is 50 % increase in diameter compared to the normal diameter of artery.

But in case of carotid bifurcation diameter should be 200 % more than ICA / 150 % of CCA

Etiology

Degenerative / Atherosclerosis

Post traumatic causes

Postendarterectomy

Vasculitis

Connective tissue disorder

Mycotic Aneurysm /SABE

Clinical features

Pulsatile mass

Painful ,tender mass , fever

Neurological symptoms

Cranial nerve dysfunction

Dysphagia

Hemorrhage and rupture

Differential diagnosis

Tortuous , kinked /coiled carotid artery

Prominent carotid bifurcation

Cervical lymphnodes overlying the carotid bifurcation

CBT

Cervical metastatic disease

Branchial cyst

Cystic hygroma

Investigation

Duplex ultrasound – limitation ?

CTA ; Advantages

;bony anatomical landmark

;circle of willis

; brain imaging

Treatment

Surgical Reconstruction

Endovascular

Advantage Avoiding difficult dissection

Proximal control is difficult

Reduce the risk of cranial nerve injuries

CONTRAINDICATION

Unstable Thrombs

Very tortuous carotid arteries

Post procedure

Surgical reconstruction ; Aspirin

Endovascular treatment ; clopidogrel

: Aspirin

* Statins

Form 2010 – 2013 we have total 29 cases

Out of them 18 have surgical reconstruction

11 have endovascular procedure

European journal of vascular &

endovascular surgery From Jan 1998 to Dec 2011 ,50

consecutive interventions for ICA aneurysmal disease was performed

3 patients developed major stroke

6 patients had cranial nerve injuries

3 patients had Thrombosis

Conclusion; surgical treatment provided satisfactory early & long term result,selected patients with non infected aneurysm endovascular option seems to be feasile

Reference

Otolaryngology head & neck surgery ; Charles W. Cummings

Surgery of the chest ; Sabiston & Spencer

Thank you