gms | German Medical Science

Objective: MRI studies are frequently performed in patients in whom carotid artery stenosis has to be excluded due to suspicious clinical symptoms and sonographic investigations. In some of these cases incidental cerebral aneurysms are diagnosed in conjunction with an extracranial disease. Questions arise whether these patients have to be treated by endovascular or/and neurosurgical means.

Methods: We analyzed our data for extracranial carotid artery stenosis associated with incidental cerebral aneurysms. Treatment strategies were evaluated for their procedure-related complications and clinical outcome.

Results: In the past four years three patients presenting with symptomatic extracranial carotid artery disease were admitted to our clinic. Concomitant non-ruptured cerebral aneurysms, located at the middle cerebral artery (MCA) on the side of the stenosis, were diagnosed by MRA. Endovascular balloon dilatation and stenting was performed in two patients followed by platelet inhibition. Fatal clinical outcome in these cases was due to rupture of the aneurysms. In one patient carotid endarterectomy and clipping of the aneurysm was uneventful. At follow-up six months later the patient had remained in good clinical condition.

Conclusions: Our own results and a review of the literature indicate that extracranial carotid surgery is to be favored in cases of associated intracranial aneurysms, especially in MCA-aneurysms. In the light of the past clinical trials comparing carotid artery stenting and carotid endarterectomy, the role of endovascular strategies in symptomatic patients with extracranial artery stenosis is still unproven. Therefore, carotid endarterectomy remains an essential skill in the toolbox of cerebrovascular neurosurgeons.