title: Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization.
abstract: BACKGROUND
  The incidence of concomitant carotid artery stenosis and unruptured intracranial aneurysms (UIAs) has been reported at between 0.5% and 5%. In these patients, treatment strategies must balance the risk of ischemic stroke with the risk of aneurysmal rupture. Several studies have addressed the natural course of UIAs in the setting of carotid revascularization; however, the final recommendations are not uniform. The purpose of this study was to review our institutional experience with concomitant UIAs and carotid artery stenosis.
  
  
  METHODS
  We performed a retrospective review of all patients with carotid artery stenosis who underwent carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) at our institution between 2003 and 2010. Only patients with preoperative imaging demonstrating intracranial circulation were included. Charts were reviewed for patients' demographic and clinical data, duration of follow-up, and aneurysm size and location. Patients were stratified into 2 groups: carotid artery stenosis with unruptured intracranial aneurysm (CS/UIA) and carotid artery stenosis without intracranial aneurysm (CS).
  
  
  RESULTS
  Three hundred five patients met the inclusion criteria and had a total of 316 carotid procedures (CAS or CEA) performed. Eleven patients were found to have UIAs (3.61%) prior to carotid revascularization. Male and female prevalence was 2.59% and 5.26% (P = 0.22), respectively. Patients' demographics did not differ significantly between the 2 groups. The average aneurysm size was 3.25 ± 2.13 mm, and the most common location was the cavernous segment of the internal carotid artery. No patient in the study had aneurysm rupture, and the mean follow-up time was 26.5 months for the CS/UIA group.
  
  
  CONCLUSIONS
  Concomitant carotid artery stenosis and UIAs is a rare entity. Carotid revascularization does not appear to increase the risk of rupture for small aneurysms (<10 mm) in the midterm. Although not statistically significant, there was a higher incidence of aneurysms found in females in our patient population.
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Borkon
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Han
authors.initials: H
authors.lastname: Hoang
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Caron
authors.initials: C
authors.lastname: Rockman
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Firas
authors.initials: F
authors.lastname: Mussa
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Neal S
authors.initials: NS
authors.lastname: Cayne
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Thomas
authors.initials: T
authors.lastname: Riles
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, New York, NY.
authors.forename: Jafar J
authors.initials: JJ
authors.lastname: Jafar
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman
authors.affiliation: Division of Vascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: thomas.maldonado@nyumc.org.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome