O-053 - LONG TERM OUTCOMES OF CONSERVATIVE TREATMENT OF EXTRACRANIAL CAROTID ARTERY ANEURYSMS : RESULTS OF THE INTERNATIONAL CAROTID ANEURYSM REGISTRY

TOPIC:
Peripheral Arterial Aneurysms
AUTHORS:
Willemsen S. (University Medical Center Utrecht ~ Utrecht ~ Netherlands) , De Borst G.J. (University Medical Center Utrecht ~ Utrecht ~ Netherlands) , Study Group C. (University Medical Center Utrecht ~ Utrecht ~ Netherlands)
Introduction:
Aneurysms of the extracranial carotid artery (ECAAs) are rare, accounting for less than 1% of all peripheral artery aneurysms. Due to the rarity of the disease, no evidence based treatment protocols have been developed.1,2 Long term assessment of ECAAs is needed to learn on the natural course of this pathology and to eventually develop an treatment guidelines. The Carotid Aneurysm Registry (CAR) is an international registry which aims to provide a better insight into this rare disease. This paper reports the long term outcomes of the first large series of conservatively treated ECAA patients.
Methods:
The CAR is a prospective, multicenter, ongoing international registry. Since 2014, clinical symptoms, etiology, type of treatment and follow-up data have been registered in patients with primary ECAA. 3 Growth was defined as a >2mm increase in diameter over time with a minimum interval of 12 months. Follow-up and treatment including antithrombotic therapy was conducted on a personalized basis, according to local practice. Primary endpoints of this study were ipsilateral ischemic cerebrovascular events. Mortality, growth of the index aneurysm, growth of new carotid aneurysms, rupture of the aneurysm and reinterventions were analyzed as secondary endpoints.
Results:
In total, 164 conservatively treated ECAA patients were included from 8 centers. Mean age was 55.9 years (SD 14.1) and 97 patients were male (59.1%). Median diameter of the ECAA was 10mm (IQR 8-14). 112 patients (68.3%) were given antithrombotic medication. Median follow up time was 29 months (IQR 11-60). Two patients (1.2%) had a stroke, both patients that were unfit for surgical or endovascular treatment. Three patients (1.8%) had a transient ischemic attack (TIA), two of these patients received a change of medication and one patient had an endovascular procedure take place. All five events occurred in patients with an aneurysm size larger than the third percentile (median 31mm, IQR 18.5-36.5) and all five were already on antithrombotic medication. Fourteen patients (8.5%) died during follow up, one patient (0.6%) died of ECAA related causes. Fifteen patients (9.1%) showed significant growth of the ECAA. One patient with observed growth underwent ECAA exclusion by surgery. One patient with observed growth had a TIA and was treated with endovascular techniques. One patient refused surgical treatment despite continuous growth. In the other 12 patients the growth stabilized and is still being monitored. Five patients (3.0%) formed a new ipsilateral or contralateral carotid aneurysm. No ruptures occurred.
Conclusion:
Our CAR data suggest that conservative treatment may be appropriate for the majority of patients with primary ECAA. While rupture does not seem to occur, the risk of ipsilateral stroke occurs to be low in small diameter ECAA. The registry will need continuation of data collecting especially on patients with larger (> 3 cm ) diameter aneurysms to study the effect of antithrombotic therapy and the risk for cerebrovascular events.
References:
1. Pourier VEC, Welleweerd JC, Kappelle LJ, et al. Experience of a single center in the conservative approach of 20 consecutive cases of asymptomatic extracranial carotid artery aneurysms. Eur J Neurol. 2018;25(10):1285-1289. 2. Fankhauser GT, Stone WM, Fowl RJ, et al. Surgical and medical management of extracranial carotid artery aneurysms. J Vasc Surg. 2015;61(2):389-393. 3. Welleweerd JC, Bots ML, Kappelle LJ, et al. Rationale and design of the extracranial Carotid artery Aneurysm Registry (CAR). J Cardiovasc Surg (Torino). 2018;59(5):692-698.