BACKGROUND: The aim of present study was to report etiological causes, therapeutic strategies and short and mid-term outcome of patients diagnosed with extracranial carotid artery pseudoaneurysm, through a multicenter national registry, involving Italian academic vascular surgery centers. METHODS: A retrospective, multicenter, observational study was conducted on patients with a diagnosis of extracranial carotid artery pseudoaneurysm undergoing conservative, surgical or endovascular treatment, both urgently and electively, at Italian vascular surgery centers, over the past ten years. All patients were evaluated at 30 days, 6 months and 12 months after the diagnosis. The same ad-hoc electronic database was sent to all the Italian academic vascular surgery divisions. Endpoints of the study were: pseudoaneurysm exclusion, patency of the carotid axis, freedom from reintervention, stroke, acute myocardial infarction and death rates. RESULTS: Out of the 43 invited centers, 21 agreed to participate in the survey. A total of 100 patients (77 men) were enrolled, with a mean age of 70±15.47 years (20-95). In 59 cases, the pseudoaneurysm was secondary to previous carotid intervention, in 19 cases to iatrogenic trauma, in 8 cases to a blunt trauma of the neck, and in 1 case to infection and Takayasu’s disease, respectively. In 12 cases the origin was defined as idiopathic. Pseudoaneurysm was limited to internal carotid artery (55 cases), external carotid artery (3), and common carotid artery (26); in 14 cases both common and internal carotid artery were involved. Eight patients were symptomatic (5 strokes and 3 ischemic transitory attacks). Ninety-three patients underwent surgical treatment, while seven cases were managed conservatively. Immediate technical success was achieved in 90 out of 93 treated patients (96.7%). The pseudoaneurysm exclusion rate was 95.5%, 92.7% and 98.6%, the patency of the carotid axis rate was 100%, 100% and 98.6%, the reintervention-free rate was 91%, 87% and 85%, the death rate was 4%, 11% and 17%, and the stroke rate was 3%, 4%, and 5% respectively at 1, 6, and 12 months of follow-up. CONCLUSIONS: Although pseudoaneurysms of the extracranial carotid axis are a rarely observed condition, with extreme variability from an etiological standpoint, they are associated with high rates of reintervention, stroke, and mortality. Consequently, an early diagnosis and an appropriate therapeutic strategy are mandatory to delineate the outcome of this condition.
Insight from the Pseudoaneurysm of the Extracranial Carotid Arteries a retrospective Italian registry - PECAN Registry
Berchiolli R.Membro del Collaboration Group
;Troisi N.Membro del Collaboration Group
;Malquori V.Membro del Collaboration Group
;
2025-01-01
Abstract
BACKGROUND: The aim of present study was to report etiological causes, therapeutic strategies and short and mid-term outcome of patients diagnosed with extracranial carotid artery pseudoaneurysm, through a multicenter national registry, involving Italian academic vascular surgery centers. METHODS: A retrospective, multicenter, observational study was conducted on patients with a diagnosis of extracranial carotid artery pseudoaneurysm undergoing conservative, surgical or endovascular treatment, both urgently and electively, at Italian vascular surgery centers, over the past ten years. All patients were evaluated at 30 days, 6 months and 12 months after the diagnosis. The same ad-hoc electronic database was sent to all the Italian academic vascular surgery divisions. Endpoints of the study were: pseudoaneurysm exclusion, patency of the carotid axis, freedom from reintervention, stroke, acute myocardial infarction and death rates. RESULTS: Out of the 43 invited centers, 21 agreed to participate in the survey. A total of 100 patients (77 men) were enrolled, with a mean age of 70±15.47 years (20-95). In 59 cases, the pseudoaneurysm was secondary to previous carotid intervention, in 19 cases to iatrogenic trauma, in 8 cases to a blunt trauma of the neck, and in 1 case to infection and Takayasu’s disease, respectively. In 12 cases the origin was defined as idiopathic. Pseudoaneurysm was limited to internal carotid artery (55 cases), external carotid artery (3), and common carotid artery (26); in 14 cases both common and internal carotid artery were involved. Eight patients were symptomatic (5 strokes and 3 ischemic transitory attacks). Ninety-three patients underwent surgical treatment, while seven cases were managed conservatively. Immediate technical success was achieved in 90 out of 93 treated patients (96.7%). The pseudoaneurysm exclusion rate was 95.5%, 92.7% and 98.6%, the patency of the carotid axis rate was 100%, 100% and 98.6%, the reintervention-free rate was 91%, 87% and 85%, the death rate was 4%, 11% and 17%, and the stroke rate was 3%, 4%, and 5% respectively at 1, 6, and 12 months of follow-up. CONCLUSIONS: Although pseudoaneurysms of the extracranial carotid axis are a rarely observed condition, with extreme variability from an etiological standpoint, they are associated with high rates of reintervention, stroke, and mortality. Consequently, an early diagnosis and an appropriate therapeutic strategy are mandatory to delineate the outcome of this condition.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
