Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Qaqish N, Knipe H, et al. Carotid artery pseudoaneurysm. Reference article, Radiopaedia.org (Accessed on 29 Mar 2024) https://doi.org/10.53347/rID-20531
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.
Causes
Pseudoaneurysms can arise from varying causes which include
- trauma
- penetrating trauma
- blunt trauma
- arterial dissection
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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.
Treatment and prognosis
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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1. Shames ML, Davis JW, Evans AJ. Endoluminal stent placement for the treatment of traumatic carotid artery pseudoaneurysm: case report and review of the literature. J Trauma. 1999;46 (4): 724-6. J Trauma (link) - Pubmed citation
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2. Berne JD, Reuland KR, Villarreal DH et-al. Internal carotid artery stenting for blunt carotid artery injuries with an associated pseudoaneurysm. J Trauma. 2008;64 (2): 398-405. doi:10.1097/TA.0b013e31815eb788 - Pubmed citation
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3. Posacioglu H, Apaydin AZ, Parildar M et-al. Large pseudoaneurysm of the carotid artery in Behçet's disease. Tex Heart Inst J. 2005;32 (1): 95-8. - Free text at pubmed - Pubmed citation
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4. Ozyazicioğlu A, Koçak H, Vural u . Carotid artery pseudoaneurysm in Behcet's disease. Eur J Cardiothorac Surg. 2001;19 (6): 938-9. Eur J Cardiothorac Surg (link) - Pubmed citation
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5. Baril DT, Ellozy SH, Carroccio A et-al. Endovascular repair of an infected carotid artery pseudoaneurysm. J. Vasc. Surg. 2004;40 (5): 1024-7. doi:10.1016/j.jvs.2004.08.019 - Pubmed citation
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6. Wang W, Li MH, Li YD et-al. Treatment of traumatic internal carotid artery pseudoaneurysms with the Willis covered stent: a prospective study. J Trauma. 2011;70 (4): 816-22. doi:10.1097/TA.0b013e3181f892af - Pubmed citation
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7. Defillo A, Zelensky A, Pulivarthi S et-al. Non-infected carotid artery pseudoaneurysm 29 years after endarterectomy, endovascular management with covered stent. J Neurosurg Sci. 2012;56 (2): 145-9. J Neurosurg Sci (link) - Pubmed citation
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8. Dubose J, Recinos G, Teixeira PG et-al. Endovascular stenting for the treatment of traumatic internal carotid injuries: expanding experience. J Trauma. 2008;65 (6): 1561-6. doi:10.1097/TA.0b013e31817fd954 - Pubmed citation
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9. Kadyrov NA, Friedman JA, Nichols DA et-al. Endovascular treatment of an internal carotid artery pseudoaneurysm following transsphenoidal surgery. Case report. J. Neurosurg. 2002;96 (3): 624-7. doi:10.3171/jns.2002.96.3.0624 - Pubmed citation
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10. Rohren EM, Kliewer MA, Carroll BA et-al. A spectrum of Doppler waveforms in the carotid and vertebral arteries. AJR Am J Roentgenol. 2003;181 (6): 1695-704. AJR Am J Roentgenol (citation) - Pubmed citation
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11. Flor N, Sardanelli F, Ghilardi G et-al. Common carotid artery pseudoaneurysm after neck dissection: colour Doppler ultrasound and multidetector computed tomography findings. J Laryngol Otol. 2007;121 (5): 497-500. doi:10.1017/S0022215106005342 - Pubmed citation
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12. Iguchi H, Takayama M, Kusuki M et-al. Carotid artery pseudoaneurysm as a rare sequela of surgery for laryngeal cancer. Acta Otolaryngol. 2006;126 (5): 557-60. doi:10.1080/00016480500437401 - Pubmed citation
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13. Nadig S, Barnwell S, Wax MK. Pseudoaneurysm of the external carotid artery--review of literature. Head Neck. 2009;31 (1): 136-9. doi:10.1002/hed.20855 - Pubmed citation
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14. Naik DK, Atkinson NR, Field PL et-al. Mycotic cervical carotid aneurysm. Aust N Z J Surg. 1995;65 (8): 620-1. - Pubmed citation
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