The most common cause of extracranial CAA
is atherosclerosis. Infrequently, connective tissue
disorders, such as Marfan syndrome or Ehlers-Danlos
syndrome, and infections, such as mycotic aneurysms,
are also responsible.[
6,
7] Considering his age, our
patient was young for atherosclerosis formation in the
carotid artery and aneurysm formation in the bilateral
common carotid arteries. A concomitant disease could
not be identified, and the pathology report revealed
no mycotic infections. Although a genetic test was
not performed on the patient, the patient's medical
history, physical examination, external appearance,
and bilateral CAA suggested that a connective tissue
disease (Ehlers-Danlos vascular type) might be the cause of these aneurysms. The patient was referred to
a genetic testing facility.
Excision of the aneurysm with open surgical repair
is the first treatment option for carotid aneurysms.
Depending on the size of the aneurysm, primary repair
or graft interposition can be performed.[6-8] A less
frequently used method in open surgery is carotid
artery ligation. It may be done as a last resort when
faced with a challenging situation due to its potentially
fatal complications. A preoperative balloon occlusion
test is indicated in patients with a high risk for carotid
ligation.[3,4] The balloon occlusion test is a valuable
screening test before carotid ligation, according to the
study by Wong et al.[9] There may also be a thrombus
burden in carotid aneurysms. This thrombus may
result in a cerebrovascular event in patients like ours.
Additionally, open surgical repair should be favored
in these individuals.[6,7] The patient had a history of
cerebrovascular disease, there was a thrombus in the
aneurysm, and the aneurysm could not reach the
base of the skull, requiring open surgical repair. The
aneurysm required graft interposition for primary
repair since it was too lengthy. Due to the large surface
area covered by the aneurysm and the complexity
of the examination, a multidisciplinary approach is
necessary to avoid negative consequences. To preserve
the nerves and muscles of our patient during surgery,
we sought the aid of otolaryngology and plastic surgery
specialists.
Huyzer et al.[10] described three patients with
carotid aneurysms who underwent interposition grafts.
One of these patients had a temporary paralysis of the
facial nerve, and the other had a temporary paralysis
of the vocal cord. After 14 months of follow-up, they
discovered that all patients were alive and had no
neurological deficits.
In a 15-year retrospective study, Fankhauser et
al.[7] found 141 aneurysms and pseudoaneurysms. All
56% of the patients who received medical treatment
did not experience aneurysm-related mortality or
substantial morbidity. Asymptomatic patients were
more likely to receive nonsurgical treatment (71%) than
symptomatic patients (31%). This study demonstrates
that some patients can be followed up with medical
treatment, mainly if they are asymptomatic.
In conclusion, as extracranial CAA are associated
with increased stroke incidence and mortality, they
should be treated immediately. Open surgical repair
should be the primary option. If the cerebrovascular
event has not occurred and the patient's anatomy is acceptable, endovascular treatment may be considered
for certain elderly patients with many comorbidities.
Endovascular treatment will become increasingly
prominent as technology advances in the following
years. It should not be forgotten that asymptomatic
patients and some selected patients can be managed
with simple medicinal treatment. Choosing the
treatment, determining the source of the aneurysm,
and administering treatment for it can also prevent
future complications.
Acknowledgments: We would like to thank Prof.Dr.
Togay Müderris from the otorhinolaryngology clinic and
Prof. Ass. Dr. Berrak Karatan from the plastic surgery and
reconstructive surgery clinic for their support during the
operation.
Patient Consent for Publication: A written informed
consent was obtained from the patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept, design, data
collection and/or processing, writing the article: E.K.;
Control/supervision: Ş.B.; Analysis and/or interpretation,
literature review, critical review, references and fundings,
materials: E.K., Ş.B.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
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