Extracranial carotid artery aneurysms: Texas Heart Institute experience

J Vasc Surg. 2000 Apr;31(4):702-12. doi: 10.1067/mva.2000.104101.


Background and purpose: Aneurysms of the extracranial carotid artery (ECA) are rare. Large single-institution series are seldom reported and usually are not aneurysm type-specific. Thus, information about immediate and long-term results of surgical therapy is sparse. This review was conducted to elucidate etiology, presentation, and treatment for ECA aneurysms.

Methods: We retrospectively reviewed the case records of the Texas Heart Institute/St Luke's Episcopal Hospital, Houston, and found 67 cases of ECA aneurysms treated surgically (the largest series to date) between 1960 and 1995: 38 pseudoaneurysms after previous carotid surgery and 29 atherosclerotic or traumatic aneurysms. All aneurysms were surgically explored, and all were repaired except two: a traumatic distal internal carotid artery aneurysm and an infected pseudoaneurysm in which the carotid artery was ligated.

Results: Four deaths (three fatal strokes and one myocardial infarction) and two nonfatal strokes were directly attributed to a repaired ECA aneurysm (overall mortality/major stroke incidence, 9%); there was one minor stroke (incidence, 1.5%). The incidence of cranial nerve injury was 6% (four cases). During long-term follow-up (1.5 months-30 years; mean, 5.9 years), 19 patients died, mainly of cardiac causes (11 myocardial infarctions).

Conclusion: The potential risks of cerebral ischemia and rupture as well as the satisfactory long-term results achieved with surgery strongly argue in favor of surgical treatment of ECA aneurysms.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm / epidemiology*
  • Aneurysm / surgery
  • Aneurysm, Infected / epidemiology
  • Aneurysm, Infected / surgery
  • Aneurysm, Ruptured / epidemiology
  • Brain Ischemia / epidemiology
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / surgery
  • Carotid Artery Injuries / epidemiology
  • Carotid Artery, Internal / surgery
  • Carotid-Cavernous Sinus Fistula / epidemiology
  • Carotid-Cavernous Sinus Fistula / surgery
  • Cause of Death
  • Cranial Nerve Injuries / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Neck / blood supply
  • Retrospective Studies
  • Risk Factors
  • Stroke / epidemiology
  • Survival Rate
  • Texas / epidemiology