Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
Department of Surgery, Korea University Anam Hospital, Seoul, Republic of Korea.
Medicine (Baltimore). 2022 May 13;101(19):e29327. doi: 10.1097/MD.0000000000029327.
This single-center, retrospective study aimed to describe the anatomic and clinical characteristics of extracranial carotid artery aneurysms (ECAAs) and to compare various ECAA management strategies in terms of outcomes.A total of 41 consecutive patients, who underwent treatment for ECAAs between November 1996 and May 2020, were included in this study. The ECAAs were anatomically categorized using the Attigah and Peking Union Medical College Hospital (PUMCH) classifications. The possible study outcomes were restenosis or occlusion of the ipsilateral carotid artery after treatment and treatment-associated morbidity or mortality.The 41 patients were stratified into three groups according to the management strategies employed: surgical (n = 25, 61.0%), endovascular (n = 10, 24.4%), and conservative treatment (n = 6, 14.6%). A palpable, pulsatile mass was the most common clinical manifestation (n = 16, 39.0%), and degenerative aneurysms (n = 29, 65.9%) represented the most common pathogenetic or etiological mechanism. According to the Attigah classification, type I ECAAs (n = 24, 58.5%) were the most common. Using the PUMCH classification, type I ECAAs (n = 26, 63.4%) were the most common. There was a higher prevalence of Attigah type I ECAAs among patients who underwent surgical treatment compared with those who underwent endovascular treatment (64.0% vs 40.0%, P = .09), whereas patients with PUMCH type IIa aneurysms were more likely to receive endovascular treatment (12.0% vs 30.0%). False aneurysms were more likely to be treated using endovascular techniques (20% vs 70%, P = 0.02). Except for two early internal carotid artery occlusions (one each among patients who underwent surgical and endovascular treatments, respectively), there were no early or late restenoses or occlusions during follow-up. Cranial nerve injuries were noted in three patients after surgical treatment, and late ipsilateral strokes occurred in two patients (one each among patients who underwent endovascular and conservative treatment, respectively). There were no other treatment-associated complications or deaths during the study period.
Both surgical and endovascular treatments could be performed safely for ECAAs with good long-term results according to anatomic location and morphology.
本单中心回顾性研究旨在描述颅外颈动脉动脉瘤（ECAAs）的解剖学和临床特征，并比较不同 ECAA 管理策略的结果。
共纳入 1996 年 11 月至 2020 年 5 月期间接受 ECAAs 治疗的 41 例连续患者。使用 Attigah 和北京协和医学院医院（PUMCH）分类法对 ECAAs 进行解剖分类。可能的研究结果为治疗后同侧颈动脉再狭窄或闭塞以及治疗相关的发病率或死亡率。
根据所采用的治疗策略，将 41 例患者分为三组：手术组（n=25，61.0%）、血管内组（n=10，24.4%）和保守治疗组（n=6，14.6%）。最常见的临床表现为可触及的搏动性肿块（n=16，39.0%），退行性动脉瘤（n=29，65.9%）为最常见的发病机制或病因。根据 Attigah 分类，I 型 ECAAs（n=24，58.5%）最常见。根据 PUMCH 分类，I 型 ECAAs（n=26，63.4%）最常见。与血管内治疗相比，手术治疗患者的 Attigah Ⅰ型 ECAAs 发生率更高（64.0%比 40.0%，P=0.09），而 PUMCH Ⅱa 型动脉瘤患者更可能接受血管内治疗（12.0%比 30.0%）。假性动脉瘤更可能采用血管内技术治疗（20%比 70%，P=0.02）。除了 2 例早期颈内动脉闭塞（分别发生在手术和血管内治疗的患者中），在随访期间没有出现早期或晚期再狭窄或闭塞。3 例患者在手术后出现颅神经损伤，2 例患者在同侧出现晚期卒中（分别发生在血管内和保守治疗的患者中）。在研究期间，没有发生其他与治疗相关的并发症或死亡。
根据解剖位置和形态，手术和血管内治疗均可安全地用于 ECAAs，长期效果良好。
