Aneurysm of the carotid artery (one of the arteries in the neck)

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An aneurysm is a localized, blood-filled bulge in the wall of a blood vessel. Here, the aneurysm is located the carotid artery, one of the arteries that supplies blood to the brain. The size of the aneurysm can increase due to the pressure of the blood flow against the weakened vascular wall. Surrounding tissue can be compressed by this aneurysm, resulting in loss of function or pain. Although very rare, the aneurysm could rupture. The aneurysm can also be a nest for clot formation, and if embolization to the brain occurs, it can cause a stroke.

Causes

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An aneurysm in the carotid artery can result from an accident involving the neck region that causes a tear in the inner wall of the blood vessel (dissection), from an infection, after a previous surgery in the neck region, and it can occur in some specific diseases (connective tissue disorders). The exact mechanism of aneurysm formation is still unclear, but we do know it is a multifactorial mechanism.

Signs and symptoms

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Most aneurysms in the neck do not have symptoms. They are usually discovered in a routine examination. A (pulsating) mass is the most common sign of a symptomatic aneurysm. This mass can cause pressure on the nerves in the neck region, and this could result in hoarseness or difficulty in swallowing. The aneurysm can also be a nest for clot formation, and if embolization occurs, blood vessels to the brain can be temporarily or permanently blocked. This blockage can result in loss of brain function manifesting as sudden loss of strength, sudden visual disturbances, or difficulty speaking. This is called a stroke.

Diagnosis

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During a physical examination, these aneurysms are often hard to detect. Most diagnoses are made during an ultrasound examination. Ultrasound images (sonograms) are made by sending a pulse of ultrasound into tissue using an ultrasound transducer (probe). The sound reflects and echoes off parts of the tissue, creating an image. Other methods to examine the carotid artery are computed tomography (CT) scan, magnetic resonance imaging (MRI), and angiography (imaging of the blood vessels after injecting a radiopaque contrast agent).

Treatment

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The best treatment for individual patients with ECAA is not clear. Invasive treatment is generally accepted as the treatment of choice for symptomatic patients and patients with a large aneurysm. Different treatment options are available:

Wait and see: Small aneurysms that are asymptomatic and stable in size need not be treated immediately. Management, consisting of regular follow-up by a vascular specialist and appropriate medication, is considered standard therapy for these aneurysms. Typically, the patient will undergo a regular ultrasound examination to monitor growth of the aneurysm.

Surgical treatment: Surgery by a vascular surgeon is the most common invasive treatment in patients with a symptomatic ECAA. The aneurysm is removed, and reconstruction of the blood vessel can be done with a vein or synthetic material.

Endovascular treatment: Endovascular procedures are performed by the interventional radiologist, sometimes with a vascular surgeon. Through an artery in the leg, catheters are introduced into the carotid artery, and a stent is placed inside the aneurysm. This endoprosthesis will line the inside of the aneurysm, reduce the pressure on the vascular wall, and also decrease the possibility of clot formation. This procedure is performed using radiographic techniques in an operating room or angiography room.

What does this study mean for you?

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In this online registry, we collect data of patients with an aneurysm of the carotid artery. These data will be used for research purposes only. The objective of this study is to improve information for patients with a carotid artery aneurysm. Our intention is to collect and share data with doctors about the natural history of the disease and the treatment options.

The database contains data on the patient’s age, symptoms, selected treatment, and how the patient is doing in the years after treatment. The treatment a patient is receiving is decided by his or her treating physician and is independent of this study.

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