Baylor Scott and White, The Heart Hospital; Plano, TX.
Baylor Scott and White, The Heart Hospital; Plano, TX.
Ann Vasc Surg. 2022 Jul;83:349-357. doi: 10.1016/j.avsg.2022.02.006. Epub 2022 Mar 4.
Extracranial carotid artery aneurysms (ECAA) are rare. Open surgery has traditionally been the treatment of choice, and endovascular management has recently been increasingly described. However, operative guidelines have not been defined.
A systematic review following PRISMA guidelines was performed to identify articles related to the symptoms, treatments, and outcomes of ECAAs. Included studies were further evaluated to identify distribution of treatment strategy based on anatomical location by Attigah classification (Type I-V) and aneurysmal type (true versus pseudoaneurysm).
Twenty-eight retrospective reviews were included. A total of 906 patients (63% male) with 959 ECAAS were identified. The most common presenting symptoms included neck mass (45%) and neurological deficits (26%), while 218 (23%) were asymptomatic. True aneurysms accounted for 52% and pseudoaneurysms for 45% of cases. Of the 959 ECAAs, 750 were treated with open surgery, 85 with an endovascular procedure, and 124 conservatively. Perioperative complications of open surgery included cranial nerve injuries (CNI) in 9% (68), strokes in 4% (27), and death in 2% (18) of cases. There were no CNI, perioperative stroke, or perioperative mortality associated with 85 endovascular procedures; however, there was 1 case of restenosis (1%). Of the 124 patients treated conservatively, 3% (4) died as a result of the aneurysm. Twenty-two of 28 studies (688 ECAAs) reported anatomical location according to Attigah classification. The distribution of ECAAs were Type I (296/688; 43%), Type II (19/688; 3%), Type III (195/688; 28%), Type IV (76/688: 11%), and Type V (102/688; 15%). Eleven of 28 studies (241 ECAAs) reported treatment choice according to Attigah classification and revealed that the majority of Type I (82%), Type II (81%), Type III (91%), and Type IV (100%) ECAAs were treated via open surgery, while Type V ECAAs were evenly treated by open surgery and endovascular surgery. Twenty-three of 28 studies (780 ECAAs) reported treatment choice stratified by aneurysmal type. Of 417 true ECAAs, 88% were treated open surgically, 4% were treated endovascularly, and 8% were treated conservatively. Of 357 pseudoaneurysms, 67% were treated open surgically, 14% were treated endovascularly, and 19% were treated conservatively.
Most reported patients with ECAAs are symptomatic. Type I and III account for more than two-thirds of ECAAs, while true aneurysms account for roughly half. The vast majority of ECAAs have been treated surgically with results comparable to reoperative carotid endarterectomy. In selected patients, endovascular treatment has been very successful with no reported morbidity or mortality.
颅外颈动脉动脉瘤（ECAA）较为罕见。传统上，开放性手术一直是首选治疗方法，最近腔内管理也越来越多地被描述。然而，尚未制定手术指南。
我们按照 PRISMA 指南进行了系统评价，以确定与 ECAA 的症状、治疗和结局相关的文章。纳入的研究进一步进行评估，根据 Attigah 分类（I 型-V 型）和动脉瘤类型（真性与假性动脉瘤）确定基于解剖位置的治疗策略分布。
共纳入 28 项回顾性研究。共纳入 906 例（63%为男性）959 例 ECAA 患者。最常见的首发症状包括颈部肿块（45%）和神经功能缺损（26%），而 218 例（23%）无症状。真性动脉瘤占 52%，假性动脉瘤占 45%。959 个 ECAA 中，750 个采用开放性手术治疗，85 个采用血管内治疗，124 个保守治疗。开放性手术的围手术期并发症包括颅神经损伤（CNI）9%（68 例）、脑卒中 4%（27 例）和死亡率 2%（18 例）。85 例血管内治疗无 CNI、围手术期脑卒中或围手术期死亡，但有 1 例发生再狭窄（1%）。124 例保守治疗的患者中，有 3%（4 例）因动脉瘤而死亡。28 项研究中有 22 项（688 个 ECAA）报告了根据 Attigah 分类的解剖位置。ECAA 的分布为 I 型（296/688；43%）、II 型（19/688；3%）、III 型（195/688；28%）、IV 型（76/688：11%）和 V 型（102/688；15%）。28 项研究中有 11 项（241 个 ECAA）根据 Attigah 分类报告了治疗选择，结果显示大多数 I 型（82%）、II 型（81%）、III 型（91%）和 IV 型（100%）ECAA 采用开放性手术治疗，而 V 型 ECAA 则采用开放性手术和血管内治疗。28 项研究中有 23 项（780 个 ECAA）根据动脉瘤类型报告了治疗选择。417 个真性动脉瘤中，88%采用开放性手术治疗，4%采用血管内治疗，8%采用保守治疗。357 个假性动脉瘤中，67%采用开放性手术治疗，14%采用血管内治疗，19%采用保守治疗。
大多数报告的 ECAA 患者均有症状。I 型和 III 型占 ECAA 的三分之二以上，而真性动脉瘤约占一半。绝大多数 ECAA 均采用手术治疗，结果与再次颈动脉内膜切除术相当。在选择的患者中，血管内治疗非常成功，无发病率或死亡率报告。
