Endovascular and Hybrid Treatment of Extracranial Carotid Artery Aneurysms: Long Term Results from the International Carotid Aneurysm Registry
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To evaluate the procedural and long term outcomes of endovascular treatment of extracranial carotid artery aneurysms (ECAAs). METHODS: Within the prospective international Carotid Aneurysm Registry, patients with primary ECAA treated with endovascular or hybrid therapy were analysed. Hybrid therapy involved a combination of surgical correction of proximal elongation and distal stenting. Technical approach and follow up were determined locally. The primary endpoint was ECAA exclusion. Secondary endpoints included technical success, peri-procedural complications, stent patency, long term ipsilateral stroke, and death. RESULTS: Between January 2014 and November 2024, 481 patients were included in the Carotid Aneurysm Registry. Of these, 42 patients (mean age 52 ± 17 years; 25 [60%] men) underwent elective endovascular ECAA exclusion (n = 37) or hybrid treatment (n = 5); 16 patients were symptomatic. One procedure was converted to open surgery due to technical failure. Thirty day outcomes revealed three ipsilateral strokes. One patient died of a stroke within 30 days. Follow up (median 65 months; interquartile range 28, 91) revealed 100% stent patency. ECAA exclusion was 95% at 12 months and 98% at a median of 65 months. One patient required additional coiling and another underwent re-stenting due to stent migration, both within the first year. During a median survival of 88 months, four patients died due to non-ECAA related causes. No ipsilateral stroke occurred in this timeframe. CONCLUSION: In this registry based, prospectively collected cohort, endovascular treatment of selected ECAAs seems technically feasible and effective for aneurysm exclusion. However, this treatment comes with high peri-procedural morbidity and mortality rates. Long term outcomes showed a high stent patency rate and successful ECAA exclusion during follow up. These findings should be counterbalanced against natural course and open surgical outcome data to design a future individualised treatment algorithm for patients with ECAA.
Authors: Saskia I. Willemsen, Nikita K.N. Jorritsma, Rodolfo Pini, Zoltan Szeberin, Gianluca Faggioli, Constantijn E.V.B. Hazenberg, Gert J. de Borst, Martin Björck, Roberto Chiesa, Jan-Willem Daemen, Lazar Davidovic, Edit Dósa, Robert Geelkerken, Eline van Hattum, Harue Santiago Kumakura, Constance van Laarhoven, Miroslav Markovic, Daniele Mascia, Barend Mees, Theo Menting, Joakim Nordanstig, Vanessa Pourier, Erasmo Simão da Silva, Sofia Strömberg, Raechel Toorop, Jantien Welleweerd
Institutions: Utrecht University, University Medical Center Utrecht, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Semmelweis University, Uppsala University, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Maastricht University Medical Centre, Maastricht University, University of Belgrade, Univerzitetski Klinički Centar Srbije, University of Twente, Universidade de São Paulo, Medisch Spectrum Twente, University of Gothenburg
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,000
OpenAlex ID: W4416866905