Aneurysm of the carotid artery (arteries in the neck)

An aneurysm is a local, blood-filled bulge in the wall of a blood vessel. The aneurysm is located in the extracranial (outside of the skull) carotid artery, one of the arteries that supplies blood to the brain. The aneurysm is often found by coincidence. 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

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, or after a previous surgery in the neck region, and it can occur in some specific diseases (connective tissue disorders like Ehlers-Danlos or Marfan syndrome). The exact mechanism of aneurysm formation is still unclear, but we do know it is a multifactorial mechanism.

Information for patients 

Signs and symptoms

Most patients with aneurysms in the neck do not have any symptoms. They are usually discovered during a routine imaging scan. 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 TIA or stroke, and are in case of an extracranial carotid aneurysm rare. 

Diagnosis

During physical examination, extracranial carotid aneurysms are often hard to detect. The diagnosis is therefore often made with the help of various imaging techniques. 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 a computed tomography (CT) scan, magnetic resonance imaging (MRI), and angiography (imaging of the blood vessels after injecting a radiopaque contrast agent).

Treatment

The best treatment for individual patients with ECAA is still under debate. 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, is considered standard therapy for these aneurysms. This usually means that a CT examination with contrast will take place at regular intervals to see if the aneurysm is growing. 

Conservative treatment: Medications are prescribed to prevent blood clotting and keep the blood vessels as fit as possible. 

Endovascular treatment: This technique may be performed by an interventional radiologist, vascular surgeon, or both. The catheters are introduced into the aorta via the inguinal arteries. A stent is then placed on the inside of the aneurysm. This so-called endoprothesis is placed as a kind of new inner tube inside the aneurysm. As a result, the pressure disappears from the wall and the chance of blood clotting is reduced. The procedure is carried out under (X-ray) examination in the operating or angio room. The patient is under general anesthesia during the treatment.

Surgical (open) treatment: The operation is performed by the vascular surgeon. The aneurysm is completely removed and the continuity of the blood vessel is restored with a patch of internal (own vein) or external (e.g. bovine) material. The patient is under general anesthesia during the treatment.

Hybrid treatment: During one operation, the aneurysm is treated both endovascularly and surgically, often by the vascular surgeon in collaboration with the interventional radiologist. The patient is under general anesthesia during the treatment.

What is the purpose of the research "Carotid Aneurysm Registry"?

The Carotid Aneurysm Registry (CAR) collects all medical and imaging information of patients with an aneurysm of the extracranial carotid artery, from diagnosis up to years after. The medical data are collected and registered. At time of registration, it is not yet known for which specific research the data will be used. In general, this concerns research involving the causes for aneurysms, research that can lead to better diagnosis of aneurysms, and research that will demonstrate the best possible care for ECAA patients world-wide. 

The registry collects e.g. age of the patient, sort of presenting complaints, type of treatment, and how the patient thrives the years after diagnosis.

What does this study mean for you?

You are expected to visit the regular appointments with your treating physician. You do not have to undergo additional treatments or examinations. 

If you participate in the Carotid Aneurysm Registry, we will ask for your permission to store your data anonymized indefinitely. All data will be stored encrypted and secured. Your name, and other data that directly identify you, are omitted.

If you are unable to visit the outpatient clinic, we will send a short questionnaire annually by e-mail or if desired by telephone. 

Participating in the study does not provide you with a direct benefit. However, the results of the research can improve your care and that of other people with similar conditions in the future. 

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