Carotid artery aneurysm: Evolution of management over two decades

Wei Zhou, Peter H. Lin, Ruth L. Bush, Eric Peden, Marlon A Guerrero, Thomas Terramani, Dieter F. Lubbe, Liz Nguyen, Alan B. Lumsden

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Introduction: Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period. Methods: Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. Results: A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by neurological symptoms (n=6, 14%). Twenty two (52%) were atherosclerotic aneurysms, fifteen (36%) false aneurysms, and five (12%) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five patients underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 patients underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69%). Conclusions: Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.

Original languageEnglish (US)
Pages (from-to)493-496
Number of pages4
JournalJournal of Vascular Surgery
Volume43
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

Fingerprint

Carotid Arteries
Aneurysm
Ligation
Length of Stay
Cranial Nerve Injuries
Therapeutics
False Aneurysm
Angioplasty
Stents
Comorbidity
Neck
Stroke
Demography
Transplants
Equipment and Supplies
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Zhou, W., Lin, P. H., Bush, R. L., Peden, E., Guerrero, M. A., Terramani, T., ... Lumsden, A. B. (2006). Carotid artery aneurysm: Evolution of management over two decades. Journal of Vascular Surgery, 43(3), 493-496. https://doi.org/10.1016/j.jvs.2005.11.023

Carotid artery aneurysm : Evolution of management over two decades. / Zhou, Wei; Lin, Peter H.; Bush, Ruth L.; Peden, Eric; Guerrero, Marlon A; Terramani, Thomas; Lubbe, Dieter F.; Nguyen, Liz; Lumsden, Alan B.

In: Journal of Vascular Surgery, Vol. 43, No. 3, 03.2006, p. 493-496.

Research output: Contribution to journalArticle

Zhou, W, Lin, PH, Bush, RL, Peden, E, Guerrero, MA, Terramani, T, Lubbe, DF, Nguyen, L & Lumsden, AB 2006, 'Carotid artery aneurysm: Evolution of management over two decades', Journal of Vascular Surgery, vol. 43, no. 3, pp. 493-496. https://doi.org/10.1016/j.jvs.2005.11.023
Zhou, Wei ; Lin, Peter H. ; Bush, Ruth L. ; Peden, Eric ; Guerrero, Marlon A ; Terramani, Thomas ; Lubbe, Dieter F. ; Nguyen, Liz ; Lumsden, Alan B. / Carotid artery aneurysm : Evolution of management over two decades. In: Journal of Vascular Surgery. 2006 ; Vol. 43, No. 3. pp. 493-496.
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abstract = "Introduction: Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period. Methods: Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. Results: A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93{\%}), followed by neurological symptoms (n=6, 14{\%}). Twenty two (52{\%}) were atherosclerotic aneurysms, fifteen (36{\%}) false aneurysms, and five (12{\%}) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55{\%}), six resection with patch angioplasty (27{\%}), and four carotid ligation (18{\%}). In group II, five patients underwent resection with interposition placement (25{\%}) and one carotid ligation (5{\%}). The remaining 14 patients underwent endovascular interventions (70{\%}) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14{\%} vs. 5{\%} (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14{\%} vs. 5{\%} (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69{\%}). Conclusions: Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.",
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AU - Zhou, Wei

AU - Lin, Peter H.

AU - Bush, Ruth L.

AU - Peden, Eric

AU - Guerrero, Marlon A

AU - Terramani, Thomas

AU - Lubbe, Dieter F.

AU - Nguyen, Liz

AU - Lumsden, Alan B.

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N2 - Introduction: Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period. Methods: Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. Results: A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by neurological symptoms (n=6, 14%). Twenty two (52%) were atherosclerotic aneurysms, fifteen (36%) false aneurysms, and five (12%) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five patients underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 patients underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69%). Conclusions: Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.

AB - Introduction: Extracranial carotid artery aneurysm (CCA), although uncommon, represents a challenge to treatment strategy. The purpose of this study was to analyze the treatment evolution and clinical outcome of all patients with CCA over a two decade period. Methods: Clinical data of all patients diagnosed with CCA who underwent interventions from 1984 to 2004 were reviewed. Patients were divided into two groups. Group I (1985-1994) and group II (1995-2004) were compared with regards to clinical presentation, treatment modality, and clinical outcome. Results: A total of 42 cases of CCA were found during the study period (group I, n=22; group II, n=20). Pulsatile neck mass was the most common presenting symptom (n=39, 93%), followed by neurological symptoms (n=6, 14%). Twenty two (52%) were atherosclerotic aneurysms, fifteen (36%) false aneurysms, and five (12%) posttraumatic aneurysms. Both groups shared similar comorbidities and demographic profiles. All patients in group I underwent operative interventions, which included 12 resection with interposition bypass grafting (55%), six resection with patch angioplasty (27%), and four carotid ligation (18%). In group II, five patients underwent resection with interposition placement (25%) and one carotid ligation (5%). The remaining 14 patients underwent endovascular interventions (70%) which included seven stent-graft exclusions, six carotid stenting with coil exclusions, and one endovascular occlusion. Hospital length of stay was significantly shorter in group II than group I (3.5 vs. 9.4 days, p<0.01). The incidence of cranial nerve injury in group I and II were 14% vs. 5% (p<0.04), respectively. The 30-day mortality/major stroke rates in group I and II were 14% vs. 5% (p< 0.04), respectively. During the follow-up period (0.8 months-20 years; mean, 4.6 years), 16 patients died, largely due to cardiac etiologies (n=11, 69%). Conclusions: Treatment modality of CCA has largely evolved from operative to endovascular intervention at our institution. Treatment benefits of endovascular modality include shorter convalescent and less procedural-related complications. This evolution reflects the improvement of endovascular devices and increased utility of endovascular applications.

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