Extracranial aneurysms of the carotid artery

Aneurysms of the extracranial carotid artery represent a serious disease because of possible cerebral embolism and aneurysm rupture. Between 1960 and 1979, 28 aneurysms of the extracranial carotid artery were seen in 27 patients at our institution. Twenty-six of these patients noticed a pulsating tumor, 12 patients had neurological symptoms; 2 aneurysms were ruptured. Five times the external carotid artery, and 3 times the internal carotid artery were ligated without neurological symptoms. After aneurysm resection, the carotid artery was reconstructed in 4 cases by direct suture, and in 2 cases by patch angioplasty. Reconstruction was accomplished with a tube-graft in 9 instances, once an extra-intracranial shunt had to be performed in advance. Two patients developed neurological deficiencies after the operation (8.7%), in one of them these were permanent. In the follow-up, 20 patients were without symptoms (87%), 3 patients died after the operation (peri-operative mortality 13%). Out of the 5 non-operated patients 2 died after a short time: one of an acute myocardial infarction and one of an extensive cerebro-vascular infarction. Two patients with asymptomatic internal carotid aneurysm refused the operation and are without symptoms for 2 and 40 years respectively. Because of the potential risks of cerebro-vascular infarction and aneurysm rupture, good results of operative treatment call for an aggressive surgical approach in dealing with extracranial carotid aneurysms.