title: Management of extracranial carotid artery aneurysm.
abstract: BACKGROUND
  Aneurysms of the extracranial carotid artery (ECAA) are rare. Several treatments have been developed over the last 20 years, yet the preferred method to treat ECAA remains unknown. This paper is a review of all available literature on the risk of complications and long-term outcome after conservative or invasive treatment of patients with ECAA.
  
  
  METHODS
  Reports on ECAA treatment until July 2014 were searched in PubMed and Embase using the key words aneurysm, carotid, extracranial, and therapy.
  
  
  RESULTS
  A total of 281 articles were identified. Selected articles were case reports (n = 179) or case series (n = 102). Papers with fewer than 10 patients were excluded, resulting in the final selection of 39 articles covering a total of 1,239 patients. Treatment consisted of either conservative treatment in 11% of the cases or invasive treatment in 89% of the cases. Invasive treatment comprised surgery in 94%, endovascular approach in 5%, and a hybrid approach in 1% of the patients. The most common complication described after invasive therapy was cranial nerve damage, which occurred in 11.8% of patients after surgery. The 30 day mortality rate and stroke rate in conservatively treated patients was 4.67% and 6.67%, after surgery 1.91% and 5.16%. Information on confounders in the present study was incomplete. Therefore, adjustments to correct for confounding by indication could not be done.
  
  
  CONCLUSIONS
  This review summarizes the largest available series in the literature on ECAA management. The number of ECAAs reported in current literature is scarce. The early and long-term outcome of invasive treatment in ECAA is favorable; however, cranial nerve damage after surgery occurs frequently. Unfortunately, due to limitations in reporting of results and confounding by indication in the available literature, it was not possible to determine the optimal treatment strategy. There is a need for a multicenter international registry to reveal the optimal treatment for ECAA.
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Welleweerd
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: den Ruijter
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: B G L
authors.initials: BG
authors.lastname: Nelissen
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: G.J.deBorst-2@umcutrecht.nl.
authors.forename: G J
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000783:Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards
keywords: Aneurysm; Carotid artery; Extracranial