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Extracranial carotid artery aneurysm

Melissa L Kirkwood, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Extracranial carotid artery aneurysms are uncommon and occur in a broad range of patients due to many etiologies. True aneurysms involving all layers of the carotid arterial wall and false aneurysms both occur. Overall, extracranial carotid artery aneurysm accounts for less than 1 percent of all arterial aneurysms and approximately 4 percent of peripheral artery aneurysms [1-3]. Repair of extracranial carotid artery aneurysm represents 0.2 to 5 percent of carotid procedures depending upon the reporting institution [4].

A diagnosis may be made incidentally in asymptomatic patients or suspected based upon clinical manifestations that may include neurologic symptoms, a pulsatile mass in the neck, mass effects, or bleeding due to rupture. Any segment of the carotid artery (common, external, internal) can be affected, although the internal carotid artery is most commonly involved.

The treatment approach depends on the symptoms, etiology, and location of the carotid aneurysm. Observation is safe for some small, asymptomatic aneurysms, but repair is indicated for enlarging asymptomatic aneurysms to prevent stroke and aneurysm rupture, and for all symptomatic aneurysms. In most series, open surgical repair is more often selected for true aneurysms, infected aneurysms, and larger aneurysms causing mass effects. Endovascular repair is more often initially chosen for patients with pseudoaneurysms due to traumatic mechanisms or as a result of carotid dissection.

The classification, clinical features, and management of extracranial carotid artery aneurysm are reviewed here. Intracranial carotid artery aneurysms are discussed in detail separately. (See "Unruptured intracranial aneurysms" and "Treatment of cerebral aneurysms".)


The extracranial carotid arteries include the common carotid artery, which originates in the chest, the external carotid artery, and the internal carotid artery to the base of the skull. The anatomy of the carotid arteries is illustrated in the figures (figure 1A-C).

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Literature review current through: Nov 2017. | This topic last updated: Jan 27, 2017.
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