ABSTRACT
Carotid artery aneurysms are uncommon, but their clinical significance has long been recognized. Indeed, surgical treatment was first employed successfully in 1808 by Sir Astley Cooper,[1] a London surgeon, using the technique of proximal ligation, even then widely practiced in dealing with peripheral aneurysms. His patient lived for another 13 years. Since that time, reports of carotid aneurysms have appeared regularly in the literature, Winslow[2] collecting some 106 cases up to 1925. However, it was not until 1952 that a reconstructive surgical technique was used to deal with a carotid aneurysm,[3] and since that time the number of cases reported has increased considerably. Reconstructions, by maintaining carotid blood flow, reduce the risk of a cerebrovascular accident, so often the sequel of simple ligation, and the various surgical techniques are now fairly well standardized. Approximately 1% of carotid extracranial operations are for aneurysms.[4]
The actual total incidence of extracranial carotid artery aneurysms is relatively small, and this is perhaps best indicated by Schechter’s[5] detailed survey. He found reports of a total of only 853 carotid aneurysms in the literature up to 1977. The low incidence of carotid artery aneurysms compared to that of other extracranial aneurysms is also well demonstrated, for example, in figures from DeBakey’s[6]
unit in Houston, where there were only 37 carotid aneurysms out of a total of 8500 aneurysms which they treated surgically in the 20 years up to 1977. Another group in Ohio reported 41 carotid aneurysms from a total of 1118 peripheral aneurysms which they evaluated over a 30-year period.[7] Yet another report states that while 500 patients with occlusive carotid disease had been dealt with over a 24-year period, only 19 carotid aneurysms were treated in the same period.[8] Most
reports of carotid aneurysms in the literature have been concerned with only one or two new examples, however, and it is therefore a relatively rare condition, which has a special importance because of the threat of hemorrhage, stroke, or death that it poses.
