Atherosclerotic extracranial carotid artery aneurysms

Twenty-four atherosclerotic extracranial carotid artery aneurysms were encountered in 21 patients during a 25-year period. These represented 46% of all extracranial carotid artery aneurysms diagnosed at the University of Michigan during this period. Neurologic symptoms including amaurosis fugax, transient ischemic attacks, and stroke were present in 50% of the patients. An asymptomatic pulsatile neck mass occurred in 33%. Surgical therapy was undertaken for 18 aneurysms, and nonoperative treatment was pursued in the remaining six aneurysms. Operative therapy included 14 aneurysmectomies and four aneurysmorraphies. There were no surgical deaths. Transient perioperative neurologic deficits affected three of these patients (17%), and one individual (5%) experienced a permanent deficit. Transient cranial nerve deficits occurred in three patients (17%), and a permanent deficit was noted in one patient (5%). During a 7.6-year follow-up period no late strokes occurred among patients who were operated on. Nonoperative therapy was associated with three ipsilateral strokes during a mean follow-up period of 6.3 years. Atherosclerotic extracranial carotid artery aneurysms were associated with an exceptionally high stroke rate (50%) if treated nonoperatively. Prevention of late stroke justifies surgery, although perioperative neurologic deficits may accompany this therapy more often than with nonatherosclerotic carotid artery aneurysms.