Die chirurgische therapie des extrakraniellen karotisaneurysmas ergebnisse in einem 16-jahres-zeitraum

Background. Aneurysms of the extracranial carotid artery are very rare. Indications for surgical therapeutic intervention, surgical techniques, perioperative complications and long-term results after operative reconstruction during an observation period of 16 years were analyzed. Patient collective. Continuous clinical follow-up of 36 patients (mean age: 60.2 years, range: 30-79 years) who underwent 41 carotid artery reconstructions due to aneurysm of the extracranial carotid arteries between 1980 and 1996. Postoperative investigation included physical and neurological examination and telephone interviews. Clinical symptoms. Fifteen patients presented with pulsatile cervical tumors, 53% of these patients had experienced an episode of cerebral ischemia prior to surgery. Anatomical localization and OP-techniques. Isolated aneurysms of the internal carotid artery (type I, end-to-end anastomosis, interposition, n=14) extensive long distance aneurysms of the internal carotid artery (type II, n=7, interposition), aneurysms of the carotid bifurcation (type III, n=13, direct suture, patch-plasty) combined aneurysm of the internal and common carotid artery (type IV, n=4, interposition), isolated aneurysm of the common carotid artery (type V, n=3, interposition). Postoperative complications. After 3 of 41 carotid reconstructions a cerebral ischemia was encountered (TIA, n=l, PRIND n=l, minor stroke n=l). In nine cases, perioperative cranio-facial nerve palsies were detected. Six nerve palsies were temporary, while three were permanent. Long-term results. One year, 5 years and 10 years after surgery 100%, 94% and 80.8% of the patients are alive and 97.5%, 88.7% and 78.8%, respectively, have not experienced an ipsilateral ischemic stroke. Conclusion. Surgical intervention for extracranial carotid aneurysm is a safe procedure with good long-term results. The risk of a permanent neurological deficit is low (2.4%). Permanent cranio-facial nerve palsies were detected in 7.3% of patients.