Contemporary Outcomes of Open and Endovascular Intervention for Extracranial Carotid Artery Aneurysms: A Single Centre Experience

Song Xue; Xiao Tang; Gefei Zhao; Hanfei Tang; Yang Shen; Ethan Y Yang; Weiguo Fu; Zhenyu Shi; Daqiao Guo

doi:10.1016/j.ejvs.2020.04.042

Contemporary Outcomes of Open and Endovascular Intervention for Extracranial Carotid Artery Aneurysms: A Single Centre Experience

Eur J Vasc Endovasc Surg. 2020 Sep;60(3):347-354. doi: 10.1016/j.ejvs.2020.04.042. Epub 2020 Jul 4.

Authors

Song Xue¹, Xiao Tang¹, Gefei Zhao¹, Hanfei Tang¹, Yang Shen¹, Ethan Y Yang¹, Weiguo Fu¹, Zhenyu Shi¹, Daqiao Guo²

Affiliations

¹ Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: daqiaoguo@163.com.

PMID: 32631711
DOI: 10.1016/j.ejvs.2020.04.042

Abstract

Objective: The objective of this study was to evaluate the outcomes of open surgery (OS) and endovascular surgery (ES) for extracranial carotid aneurysm (ECCA) in the authors' centre.

Methods: Fifty-seven consecutive patients who were diagnosed with ECCA and underwent intervention from January 2005 to July 2019 at Zhongshan Hospital, Fudan University, were reviewed retrospectively. Patient characteristics and surgical outcomes for OS and ES were analysed. ECCAs were divided into three morphological subgroups: subgroup Ⅰ, no severe tortuosity of the internal carotid artery (ICA) or common carotid artery (CCA) proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅱ, severe ICA or CCA tortuosity proximal to the aneurysm, tortuosity of the aneurysm and 1 cm of peri-aneurysmal carotid artery ≤ 90°; subgroup Ⅲ, aneurysm tortuosity and 1 cm peri-aneurysmal carotid artery > 90°.

Results: 35 patients underwent OS, 20 patients underwent ES and 2 patients underwent OS after the failure of ES. Thirty-six cases were classified in subgroup Ⅰ, 11 cases in subgroup Ⅱ, and 10 cases in subgroup Ⅲ. ES was achieved successfully in all 18 cases of subgroup I, but failed in three of four cases in subgroups Ⅱ and Ⅲ. With a mean duration of 62.9 ± 44.5 months of follow up, five deaths were recorded in the OS group, two of which were caused by ipsilateral stroke and three were not neurologically related. There was no stroke or death in the ES group during follow up. One case of stroke and two cases of death occurred in symptomatic patients, while one case of stroke and three cases of death occurred in asymptomatic patients.

Conclusion: This series demonstrates that ES may be a safe and durable option for ECCA in subgroup Ⅰ, while in subgroups Ⅱ and Ⅲ, ES alone may be difficult to apply. A 30 day stroke rate around 5% existed in ECCAs with interventions, which should be considered before the intervention.

Keywords: Carotid artery disease; Endovascular procedures; Extracranial carotid artery aneurysm.

MeSH terms

Adult
Aged
Anastomosis, Surgical
Aneurysm / diagnostic imaging
Aneurysm / mortality
Aneurysm / surgery*
Carotid Artery Diseases / diagnostic imaging
Carotid Artery Diseases / mortality
Carotid Artery Diseases / surgery*
China
Endovascular Procedures* / adverse effects
Endovascular Procedures* / mortality
Female
Humans
Ligation
Male
Middle Aged
Retrospective Studies
Risk Factors
Stroke / etiology
Time Factors
Treatment Outcome
Vascular Surgical Procedures* / adverse effects
Vascular Surgical Procedures* / mortality