Carotid artery pseudoaneurysm

Last revised by Naim Qaqish on 29 Dec 2020

Carotid artery pseudoaneurysms can refer to pseudoaneurysms involving any segment of the carotid arteries.

As with pseudoaneurysms elsewhere, these lack all three layers of the arterial wall (intima, media and adventitia).

Pseudoaneurysm development can occur within hours to several years after initial arterial injury although normally presenting within 5 years 7.

Pseudoaneurysms can arise from varying causes which include

  • trauma
    • penetrating trauma
    • blunt trauma
  • arterial dissection
  • vasculitides, e.g. Behcet disease 3-4
  • infection, e.g. mycotic carotid arterial pseudoaneurysm 14
  • as an iatrogenic complication following procedures
    • following carotid endarterectomy: uncommon complication 5,7
    • following transsphenoidal surgery: rare 9
    • surgical neck dissections: rare 11-12
    • misplaced central venous lines: rare 10

Imaging evaluation is often with Doppler ultrasound and CT angiography.

Management options can range from traditional surgical repair to endovascular repair (stent placement -  combined stent placement and coil embolization 7). Mortality rates of up to 30% have been reported in the case of external carotid arterial pseudoaneurysms. In certain situations, more conservative approaches are taken (i.e observation 13)

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Cases and figures

  • Case 1: post traumatic right CCA pseudoanerusym
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  • Case 2: post carotid endarterectomy
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  • Case 3: extracranial ICA pseudoaneurysm after aneurysm coiling
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  • Case 4
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