Surgical management of extracranial internal carotid artery aneurysm—Case report and literature review

KEY CLINICAL MESSAGE: Extracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck. ABSTRACT: Extracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70‐year‐old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long‐standing coronary artery disease. Imaging investigation in terms of ultrasound and CT‐scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end‐to‐end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.