Background: Extracranial carotid artery aneurysms (ECCAs) are rare;
however, they are associated with a high risk of stroke and mortality if
untreated. In the present review, we compared the major outcomes between
open and endovascular repair of ECCAs.
Methods: We systematically searched PubMed, Embase, Scopus, and the
Cochrane Library for clinical studies reported online up to September
2020 that had evaluated major outcomes after both open and endovascular
repair of ECCAs. Eligible studies were required to have evaluated at
least the 30-day mortality or stroke and/or transient ischemic attack
rates. The quality of the studies was also evaluated.
Results: Overall, seven studies (three high quality, two medium quality,
and two low quality) with 374 patients and 383 ECCAs were eligible. All
the studies had been reported from 2004 to 2020. In total, 220 open
repairs were compared with 81 endovascular repairs. The open and
endovascular treatments showed similar 30-day mortality rates (4% vs
0%; pooled odds ratio [OR], 2.67; 95% confidence interval [CI],
0.291-24.451) and stroke and transient ischemic attack rates (5.5% vs
1.2%; pooled OR, 1.42; 95% CI, 0.412-4.886). Open repair was
associated in six studies with a greater incidence of cranial nerve
injury compared with endovascular repair (14.5% vs 0%; OR, 3.98; 95%
CI, 1.178-13.471). The hematoma or bleeding rate was also similar
between the two methods in six studies (5.2% vs 0%; OR, 1.92; 95% CI,
0.518-7.094).
Conclusions: Open and endovascular repair of ECCAs is associated with
similarly low early mortality and cerebrovascular event rates, although
open repair showed a greater risk of cranial nerve injuries. An
endovascular approach could be more appropriate when the aneurysm is
located distally or requires extensive dissection. More studies are
needed with standardized follow-up durations to evaluate late outcomes
