Symptomatic extracranial internal carotid artery aneurysm deferred repair

Extracranial carotid artery aneurysm is a rare condition (0.3-0.6% of the population), yet it has a significant cost to public health as the aneurysm is often revealed by stroke. Open and endovascular management of this condition have already been described, but no optimal treatment strategy could have been determined due to the lack of data. We present a case of a symptomatic extracranial internal carotid artery aneurysm revealed by an ischemic Sylvian stroke, followed shortly by a parenchymal haemorrhage. Surgery had to be postponed for ten weeks due to the initial risk of massive haemorrhagic transformation. To prevent thromboembolic event in the preoperative period, we introduced aspirin at first. It was replaced by tinzaparin when regression of parenchymal haemorrhage was assessed by control-computerised tomography (CT) 35 days later. No thromboembolic event happened during the preoperative period, up to Day 70 when surgery was performed. Aneurysm was successfully repaired with prosthetic polytetrafluoroethylene interposition bypass. The only complication observed was a transient XIIth cranial nerve injury due to large mobilisation during the surgery. No other neurological or cardiovascular event happened during nine months in the postoperative follow-up period. Literature about extracranial carotid artery aneurysm is scarce, mostly composed of small cases series. More data are needed to ascertain an optimal treatment strategy. In this optic, we report a case of an extracranial internal carotid artery aneurysm successfully treated surgically, after three weeks of antiplatelet therapy followed by seven weeks of anticoagulant therapy.