Successful management of a large internal carotid artery aneurysm via open resection

BACKGROUND: Extracranial carotid artery aneurysms are rare pathologies associated with an increased risk of neurological events and cranial nerve dysfunction. While they often require prompt intervention, the preferred surgical management remains unclear due to the rarity of this pathology, with described surgical and endovascular techniques having unique benefit and risk profiles in the current literature. CASE REPORT: We report an interesting case of an internal carotid artery aneurysm successfully managed via open resection in a female patient in her 70s. Our patient, who was otherwise well, initially presented with an isolated episode of dysarthria associated with hypertension. Her pathology was identified on routine work-up for a presumed neurological event in the setting of her symptoms, and the patient referred to our center for definitive surgical management given the associated risk of embolic events. Under our care, the patient underwent an open resection of the ICA aneurysm with primary repair of the vessel. Her intra-operative and post-operative courses were unremarkable, and the patient remained well with no neurological deficits at follow-up at 4 months. CONCLUSIONS: Our case demonstrates that select patients presenting with internal carotid artery aneurysms and tortuous internal carotid arteries, who may be otherwise ineligible for endovascular treatment, may be amenable to resection of the aneurysm followed by primary repair of the vessel, negating the requirement for interposition grafts