Open and Endovascular Treatment of Carotid Aneurysms

An aneurysm is generally defined as an expansion of the arterial lumen by more than 50% of its standard diameter. However, for the carotid artery, particularly due to the bulb region, this definition differs. In this context, an aneurysm is defined as a bulb dilation of 200% of the internal carotid artery’s diameter and 150% of the common carotid artery’s diameter. Most aneurysms involve the bulb region and the internal carotid artery, while aneurysms of the external carotid artery are very rare. Carotid aneurysm resection constitutes 0.1–3% of all carotid artery surgeries. The leading causes of carotid artery aneurysms include atherosclerosis, trauma, post-endarterectomy changes, congenital factors, inflammation, and fibromuscular dysplasia. Carotid aneurysms can be classified as true or false. True aneurysms typically develop due to atherosclerosis, arteritis, and fibromuscular dysplasia or are classified as pseudoaneurysms. The etiology is often post-traumatic or mycotic. A saccular aneurysm is characterized by a segmental, lateral (asymmetric) expansion of the artery, while a fusiform aneurysm involves a segmental (symmetric) expansion of the artery’s diameter. The fusiform form is more common than the saccular form, with fusiform aneurysms occurring more frequently at the bifurcation of the common carotid artery and saccular aneurysms typically found in the internal carotid artery. Carotid artery aneurysms can lead to severe complications such as distal embolization, compression symptoms, and rupture.