Lidija Erdelez

Open surgical and endovascular treatment of extracranial internal carotid artery aneurysms.

Internal carotid artery (ICA) aneurysms are rare. The symptoms are related to cerebral embolization, local compression and rupture. Options for treatment include open surgery or endovascular treatment with a covered stent. We report a case of a 67 year old woman with bilateral idiopathic internal carotid artery aneurysms, found during the diagnostic evaluation for an episode of syncope. The right ICA aneurysm was treated with resection and end-to-end anastomosis of the ICA. There were no perioperative complications. Six months later the patient underwent endovascular repair of left carotid artery aneurysm with a covered stent. There were no complications in postoperative period. Treatment options for ICA aneurysms are surgical or endovascular, depending of size, location and anatomic relation to surrounding structures.

Coil embolization and surgical removal of carotid body paraganglioma.

AbstractCarotid body paraganglioma has considerable malignant potential and locally aggressive behavior, so it should be treated as soon as it is discovered.We report the case of 60-year-old male patient with a carotid body paraganglioma (Shamblin group II) that was causing the carotid arteries to spread. Angiography showed 1 dominant feeding artery arising from the right external carotid artery. Selective angiography was performed 2 days before surgical removal of the tumor, and the feeding artery was successfully embolized with coils.Literature review reveals previous reports where preoperative embolization of the feeding arteries was done using ethanol, polymers, or other liquid agents. In our case, angiography (via femoral artery) was performed 2 days before surgical removal of the tumor, and the main feeding artery (a single branch arising from external carotid artery) was successfully embolized with coils rather than liquids.Performing coil embolization before operating reduced subsequent blood loss and made it easier to identify the feeding artery during surgery. Supraselective coiling, although as difficult as embolization with liquids, may reduce the incidence of postoperative stroke. At 1 year after surgery, the patient had no signs of tumor recurrence.