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A novel approach to high-grade carotid stenosis with concomitant extracranial carotid aneurysms using transcarotid
Michael A Corbin1, Fanny S Alie-Cusson1, David J Dexter1
1Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va.
Insights
Transcarotid artery revascularization (TCAR) offers a new approach for treating complex carotid artery conditions. This study explores TCAR for patients with both severe carotid stenosis and aneurysms, demonstrating its potential in challenging cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurosurgery
Background:
- Extracranial carotid artery aneurysms (ECAAs) are rare, often asymptomatic vascular lesions.
- Traditional treatments for ECAAs include open surgery or stent grafting.
- Transcarotid artery revascularization (TCAR) is established for high-grade carotid stenosis in high-risk patients.
Observation:
- This study presents two cases of high-risk patients with co-existing high-grade internal carotid artery stenosis and ECAAs.
- TCAR was utilized as the primary intervention for managing both conditions simultaneously.
Findings:
- TCAR was successfully applied in managing concomitant carotid stenosis and ECAAs.
- The procedure demonstrated feasibility and potential efficacy in this unique patient cohort.
Implications:
- TCAR may represent a viable alternative treatment strategy for complex carotid artery pathologies involving both stenosis and aneurysms.
- Further research is warranted to establish TCAR's role in managing ECAAs and similar combined vascular conditions.
Abstract:
We present the novel application of transcarotid artery revascularization (TCAR) in two high-risk patients with high-grade internal artery stenosis and concomitant atherosclerotic extracranial carotid artery aneurysms (ECAAs). ECAAs account for <1% of arterial aneurysms and are usually clinically silent at presentation. Historically, the treatment of ECAAs has been via open reconstruction or stent grafting. TCAR is an effective alternative for carotid revascularization in high-risk patients with high-grade carotid stenosis, but has not been widely used for aneurysmal management. We report two cases to describe our management of concomitant carotid stenoses and ECCA with TCAR.
