1. Case study

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

4. Diagnosis ?

6. History ?

7.  Any neurological deficit
 Trauma
 Any surgery
 Fever, joint pain ?

8. Examination ?

9.  Swelling
 Pulsatile mass
 Oral cavity
 Carotid bruit
 Horner’s syndrome

10. Complication ?

11.  Thromboembolism
 Neurological complications
 Rupture

12. Management ?

13.  Surgical reconstruction
 Endovascular treatment

17. Complication ?

18.  Thrombosis
 Endoleak
 Perforation
 Migration
 Infection
 Dissection of artery

19. Carotid Artery Aneurysm

20. 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

21. 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

22. Etiology
 Degenerative / Atherosclerosis
 Post traumatic causes
 Postendarterectomy
 Vasculitis
 Connective tissue disorder
 Mycotic Aneurysm /SABE

23. Clinical features
 Pulsatile mass
 Painful ,tender mass , fever
 Neurological symptoms
 Cranial nerve dysfunction
 Dysphagia
 Hemorrhage and rupture

24. Differential diagnosis
 Tortuous , kinked /coiled carotid
artery
 Prominent carotid bifurcation
 Cervical lymphnodes overlying the
carotid bifurcation
 CBT
 Cervical metastatic disease
 Branchial cyst
 Cystic hygroma

25. Investigation
 Duplex ultrasound – limitation ?
 CTA ; Advantages
;bony anatomical landmark
;circle of willis
; brain imaging

26. Treatment
 Surgical Reconstruction
 Endovascular

27. Advantage
 Avoiding difficult dissection
 Proximal control is difficult
 Reduce the risk of cranial nerve
injuries
 CONTRAINDICATION
 Unstable Thrombs
 Very tortuous carotid arteries

28. Post procedure
 Surgical reconstruction ; Aspirin
 Endovascular treatment ; clopidogrel
: Aspirin
* Statins

29.  Form 2010 – 2013 we have total
29 cases
 Out of them 18 have surgical
reconstruction
 11 have endovascular procedure

30. 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

31. Reference
Otolaryngology head & neck surgery ;
Charles W. Cummings
Surgery of the chest ; Sabiston &
Spencer

32. Thank you