Technical NoteThe use of an external-internal shunt in the treatment of extracranial internal carotid artery saccular aneurysms: technical case report
Section snippets
An illustrative case
A 55-year-old woman presented with a 5-year history of a progressively enlarging pulsatile neck mass. An examination revealed no neurological deficit. Right carotid angiogram (CAG) showed a saccular EICAA involving the internal carotid artery (ICA) distal to the bifurcation, with kinking of the ICA (Figure 1A). The dome of the EICAA extended from the upper border of C4 to the midportion of C2 and the maximum diameter was 4 cm (Figure 1A). Preoperative ICA balloon occlusion test showed a stump
Technique
At surgery, the standard carotid approach anterior to the sternomastoid muscle was used. It was difficult to control the distal ICA because of the large aneurysmal sac. After an intravenous bolus of 3000 units of heparin, vessel tapes were placed around the ICA, external carotid artery (ECA) and common carotid artery (CCA). First, all three vessels were occluded with bulldog clamps. During the occlusion the aneurysmal sac was partially incised and opened. There was no intra-aneurysmal thrombus.
Discussion
The incidence of EICAA has been reported to be less than 2% of all carotid operations 3, 6. Saccular aneurysms constitute 22–38% of EICCA 3, 6, 8. Most authors support surgical treatment for EICAA because of the high rate of neurological symptoms (38–92%) 2, 3, 5, 6. Nonoperative treatment is associated with an unacceptable stroke rate (50%) [9]. Even for asymptomatic aneurysms, operative therapy seems to be justified to prevent neurological symptoms in the future [2].
For saccular EICAA the
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