Ica aneurysm

1. Case study

2. Case
16 years male presented with
complaints of dizziness associated
with transient loss of vision ? in the
right eye over the past one month

4. Diagnosis ?

6. History ?

7. Any neurological deficit
Trauma
Any surgery
Fever, joint pain ?

8. Examination ?

9. Swelling
Pulsatile mass
Oral cavity
Carotid bruit
Horner’s syndrome

10. Complication ?

11. Thromboembolism
Neurological complications
Rupture

12. Management ?

13. Surgical reconstruction
Endovascular treatment

17. Complication ?

18. Thrombosis
Endoleak
Perforation
Migration
Infection
Dissection of artery

19. Carotid Artery Aneurysm

20. Introduction
Aneurysm of extracranial carotid
artery (ECAA) is an uncommon but
important clinical entity
Incidence of intracranial carotid
artery aneurysm (0.8 –18 %) and
ECAA is 1-1.5 %
ECAA is less than 1 % of all carotid
pathologies

21. Definition
The accepted difinition of most
arterial aneurysm is 50 % increase
in diameter compared to the normal
diameter of artery.
But in case of carotid bifurcation
diameter should be 200 % more
than ICA / 150 % of CCA

22. Etiology
Degenerative / Atherosclerosis
Post traumatic causes
Postendarterectomy
Vasculitis
Connective tissue disorder
Mycotic Aneurysm /SABE

23. Clinical features
Pulsatile mass
Painful ,tender mass , fever
Neurological symptoms
Cranial nerve dysfunction
Dysphagia
Hemorrhage and rupture

24. Differential diagnosis
Tortuous , kinked /coiled carotid
artery
Prominent carotid bifurcation
Cervical lymphnodes overlying the
carotid bifurcation
CBT
Cervical metastatic disease
Branchial cyst
Cystic hygroma

25. Investigation
Duplex ultrasound –limitation ?
CTA ; Advantages
;bony anatomical landmark
;circle of willis
; brain imaging

26. Treatment
Surgical Reconstruction
Endovascular

27. Advantage
Avoiding difficult dissection
Proximal control is difficult
Reduce the risk of cranial nerve
injuries
CONTRAINDICATION
Unstable Thrombs
Very tortuous carotid arteries

28. Post procedure
Surgical reconstruction ; Aspirin
Endovascular treatment ; clopidogrel
: Aspirin
* Statins

29. Form 2010 –2013 we have total
29 cases
Out of them 18 have surgical
reconstruction
11 have endovascular procedure

30. European journal of vascular &
endovascular surgery
From Jan 1998 to Dec 2011 ,50
consecutive interventions for ICA
aneurysmal disease was performed
3 patients developed major stroke
6 patients had cranial nerve injuries
3 patients had Thrombosis
Conclusion; surgical treatment
provided satisfactory early & long
term result,selected patients with
non infected aneurysm endovascular
option seems to be feasile

31. Reference
Otolaryngology head & neck surgery ;
Charles W. Cummings
Surgery of the chest ; Sabiston &
Spencer

32. Thank you