Carotid artery aneurysm

Carotid artery aneurysm refers to an abnormal bulge in one of your carotid arteries, which are responsible for supplying blood to your brain, head, face, and neck. Each upper chest houses a common carotid artery on both sides. These common carotid arteries divide into two branches as they ascend your neck, giving rise to the internal carotid artery and external carotid artery. While carotid aneurysms can affect any of these arteries, they most commonly develop within the internal carotid arteries.

Aneurysms occur when a section of an artery wall weakens, leading to thinning of the artery wall as the aneurysm enlarges. Consequently, there is an increased risk of the aneurysm rupturing, similar to a balloon expanding and thinning its walls until it bursts. The larger the aneurysm grows, the greater the danger it poses.

How Serious is a Carotid Artery Aneurysm?

Carotid artery aneurysms have a significant impact on blood vessels responsible for supplying the brain. While some aneurysms may remain small and symptom-free, there is a risk of blood clots forming within the aneurysm, potentially obstructing blood flow to the brain. This can lead to a transient ischemic attack (TIA), often called a “mini-stroke,” or a full-blown ischemic stroke. Larger aneurysms may rupture, resulting in a hemorrhagic stroke characterized by life-threatening bleeding.

True vs. False Carotid Artery Aneurysm

Carotid artery aneurysms can be categorized as either true or false aneurysms. These terms describe how the bulge forms within the artery wall.

A true carotid artery aneurysm affects all three layers of the artery wall, namely intima, media, and adventitia, all of which protrude outward to form the aneurysm wall. Atherosclerosis is the most common cause of true aneurysms.
A false carotid artery aneurysm, also known as a pseudoaneurysm, impacts only one or two layers of the artery wall. It typically resembles a round sac extending from the artery with a narrow “neck.” Pseudoaneurysms are commonly caused by trauma, infection, or complications arising from medical procedures.

Both true and false aneurysms can lead to complications and may require treatment.

Who is at Risk of Carotid Artery Aneurysms?

Carotid artery aneurysms can affect individuals of any age, including children, but they are most frequently diagnosed in people in their 50s or 60s.

Are Carotid Artery Aneurysms Common?

Carotid artery aneurysms are rare, accounting for fewer than 1 in 100 cases of aneurysms.

Symptoms and Causes

What are the Symptoms of a Carotid Artery Aneurysm?

While some individuals with carotid artery aneurysms remain asymptomatic, those who do experience symptoms often manifest signs of a transient ischemic attack (TIA) or a stroke. A TIA, sometimes referred to as a “mini-stroke,” serves as a warning sign indicating the potential occurrence of a stroke in the near future. Both TIAs and strokes are characterized by a disruption in blood flow to the brain and represent medical emergencies. If you experience the following symptoms, it is essential to call 911 or your local emergency number:

Difficulty seeing from one or both eyes.
Difficulty walking.
Dizziness, loss of coordination, or imbalance.
Numbness or weakness in the face, arms, or legs, especially on one side of the body.
Sudden, severe headache.
Difficulty speaking or understanding speech, often accompanied by slurred or confused speech.

In cases of severe symptoms, individuals may be unable to call for help themselves, underscoring the importance of educating loved ones about TIA and stroke symptoms. For those living alone, acquiring a medical alert system that requires merely pushing a button to seek assistance is a prudent step.

Apart from TIAs and strokes, the pressure exerted by the aneurysm on nearby structures may lead to additional symptoms. Such pressure may cause:

Headaches.
Hoarseness.
Neck pain.
Swelling in the face.
A throbbing lump palpable in the neck.
Difficulty swallowing.
Vision problems.

Individuals experiencing any of these symptoms should promptly contact their healthcare provider.

What Causes Carotid Artery Aneurysms?

Carotid artery aneurysms can result from various causes, including:

Atherosclerosis (most common).
Conditions that weaken the artery walls, such as fibromuscular dysplasia and connective tissue diseases.
Complications arising from medical procedures, such as carotid endarterectomy, central line placement, or radiation therapy.
Traumatic injuries to the artery, such as gunshot or stab wounds.

What are the Risk Factors for Carotid Artery Aneurysms?

Carotid artery aneurysms are primarily associated with the weakening of artery walls. Several factors can increase the risk of weakened arterial walls, including:

Family history of aneurysms.
High blood pressure (hypertension).
Smoking or tobacco use.

Diagnosis and Tests

How is a Carotid Artery Aneurysm Diagnosed?

Healthcare providers typically diagnose carotid artery aneurysms through:

Physical examination, which includes listening to blood flow through the carotid artery with a stethoscope. The presence of a whooshing sound (carotid bruit) may indicate a carotid artery aneurysm.
Evaluation of family history, involving questions about medical conditions affecting biological family members, as aneurysms often run in families.
Assessment of medical history to identify potential causes of an aneurysm.
Imaging tests that visualize the interior of the carotid artery and the surrounding areas, confirming the diagnosis and guiding the treatment plan.

Aneurysms are sometimes diagnosed incidentally during imaging tests conducted for other reasons.

What Tests Diagnose Carotid Artery Aneurysms?

Imaging tests used to diagnose carotid artery aneurysms include:

Computed tomography (CT) scan.
Magnetic resonance angiography (MRA).
Ultrasound.

Additional tests your provider may recommend include:

Brain imaging to assess blood flow in the brain and identify other aneurysms.
Genetic testing to check for underlying genetic conditions.
Imaging tests to examine your aorta or other arteries for additional aneurysms.

Management and Treatment

What is the Treatment for Carotid Artery Aneurysms?

The treatment of carotid artery aneurysms encompasses three primary approaches:

Surveillance: Also known as “watchful waiting,” surveillance involves regular monitoring of the aneurysm. Periodic ultrasound, CT, or MRI scans every six to twelve months allow providers to detect any changes in the aneurysm’s size or condition. Surveillance is often a suitable option for small, asymptomatic aneurysms.
Open surgery: Surgical repair is the conventional treatment method, involving the removal of the damaged section of the carotid artery. This is followed by the creation of a new path for blood flow to circumvent the aneurysm site. Bypass grafting may be used, utilizing either a portion of a blood vessel from another part of the body or an artificial material like GORE-TEX®.
Endovascular stent grafting: This less invasive alternative to open surgery is considered for eligible cases based on the aneurysm’s size and location within the carotid artery. Endovascular procedures involve inserting a stent graft into the blood vessels through catheters, guided by X-ray imaging. The graft is positioned within the aneurysm, where metallic hooks secure it in place, serving as a new path for blood flow.

The choice of treatment depends on individual factors and is made after a thorough discussion between the provider and the patient, weighing the benefits, risks, and potential side effects of each approach. The decision is also influenced by the aneurysm’s size, growth rate, and the presence or absence of symptoms.

Prevention

How can I Reduce my Risk of a Carotid Artery Aneurysm?

While certain risk factors like family history may be beyond your control, you can take steps to maintain healthy arteries and reduce the risk of aneurysms. These steps include:

Avoiding smoking, vaping, and tobacco use. Seek resources from your provider to aid in smoking cessation.
Adopting a heart-healthy diet low in saturated fat, sodium, and sugar.
Engaging in regular exercise in accordance with your provider’s guidance.
Limiting alcohol consumption.
Managing risk factors like high blood pressure.
Adhering to prescribed medications.
Scheduling yearly check-ups and attending all follow-up appointments with your provider.

Outlook / Prognosis

What Can I Expect if I Have a Carotid Artery Aneurysm?

The outlook for individuals with carotid artery aneurysms can vary significantly. While some may have small, asymptomatic aneurysms monitored over several years, others may experience rapid aneurysm growth necessitating treatment. Surgical and endovascular procedures are available options but carry inherent risks. It is important to engage in open and honest discussions with your provider to understand your specific condition and what to expect in your future.

Living With

How Do I Take Care of Myself?

Following the guidance of your healthcare provider regarding lifestyle changes is essential to manage your condition effectively. In addition, inquire about any recommended activity restrictions to prevent overexertion.

When Should I See My Healthcare Provider?

Regularly attending appointments and adhering to your provider’s schedule for testing and follow-ups is crucial. Notify your provider if you experience:

New or changing symptoms.
Side effects from prescribed medications.
Questions or concerns about your aneurysm or treatment plan.

When Should I Go to the Emergency Room?

If you experience symptoms of a heart attack, stroke, or transient ischemic attack (TIA), it is imperative to call 911 or your local emergency number immediately.

What Questions Should I Ask My Doctor?

If you have been diagnosed with a carotid artery aneurysm, it’s natural to have numerous questions. To begin the conversation with your provider, consider asking questions such as:

Where is the aneurysm located, and is it in my neck or skull?
What is the size of the aneurysm?
Will I require treatment, and if so, when?
What are the available treatment options?
What are the benefits and risks associated with each treatment option?
What should I expect during the recovery process?
What lifestyle changes should I make?
Are there any activity restrictions for me?
Do I need additional testing, and if so, how frequently?

Additional Common Questions:

What is the Difference Between an Extracranial Carotid Artery Aneurysm and an Intracranial Carotid Artery Aneurysm?

Both extracranial and intracranial carotid artery aneurysms pertain to aneurysms affecting the carotid arteries. The distinction between these terms lies in the location of the aneurysm within the artery.

Extracranial carotid artery aneurysms are positioned outside the skull, primarily within the neck.
Intracranial carotid artery aneurysms occur within the skull.

The internal carotid artery, which runs from the neck to the brain, has both extracranial and intracranial segments. These terms help describe the location of the aneurysm within the artery. Understanding this anatomical context can be beneficial when discussing your condition with your healthcare provider. For instance, your provider may refer to an “aneurysm in the left internal carotid artery, cervical segment,” indicating an aneurysm outside of the skull on the left side. Feel free to ask your provider for clarification on any terms or aspects of your condition that may be unclear.

Carotid artery aneurysm