Volume 50, Issue 2 Summer 2026 JVU 502-93 | Internal Carotid Artery Aneurysms Demonstrated with Computed Tomographic Angiography, Ultrasound, and Angiography: Case Series-Internal Carotid Artery Aneurysms

Internal Carotid Artery Aneurysms

Pdf Summary

This case series describes two patients with rare extracranial carotid artery aneurysms (ECAAs), emphasizing the importance of multimodal imaging and individualized treatment. ECAAs are uncommon, accounting for less than 1% of arterial aneurysms, but they can cause serious complications such as stroke, nerve compression, rupture, or fatal hemorrhage if untreated. They may be true aneurysms or pseudoaneurysms, and causes include atherosclerosis, trauma, infection, connective tissue disorders, dissection, and iatrogenic injury.<br /><br />In Case 1, a 74-year-old man presented with a palpable pulsatile left neck mass. Carotid duplex ultrasound with color Doppler detected a saccular outpouching connected to the left internal carotid artery, with swirling flow suggestive of aneurysm. CTA confirmed a proximal left ICA aneurysm. No treatment record was available.<br /><br />In Case 2, a 79-year-old woman had a pulsatile right neck mass. CTA showed a large saccular aneurysm at the right carotid bifurcation involving the origins of the ICA and ECA. She underwent transcarotid artery revascularization with stent placement and coil embolization. Follow-up angiography and post-procedural CTA showed improved exclusion of the aneurysm and patent flow through the stented ICA. Subsequent carotid duplex ultrasound confirmed continued vessel patency and visualized the stent and coils.<br /><br />The authors conclude that carotid duplex ultrasound is the preferred initial test for suspected ECAA because it is noninvasive and useful for surveillance, but CTA, MRA, and angiography are important for confirmation and treatment planning. Endovascular approaches, including TCAR, offer effective alternatives to open surgery with lower complication rates, though long-term monitoring and anticoagulation remain important.

Keywords

extracranial carotid artery aneurysm

ECAA

carotid duplex ultrasound

color Doppler

computed tomography angiography

CTA

transcarotid artery revascularization

stent placement

coil embolization

endovascular treatment