Management of a giant right common carotid artery aneurysm with concomitant significant stenosis of LICA using surgical and endovascular techniques - case report and review

Extracranial carotid artery aneurysms (ECAA) are rare vascular anomalies, often associated with significant clinical challenges due to their potential to cause severe neurological deficits. This case report details the management of a giant right common carotid artery aneurysm (RCCAA) concomitant with significant stenosis of the left internal carotid artery (LICA). A 65-year-old male presented with a pulsatile neck mass and symptoms of compression, including hoarseness and neck pain. Diagnostic imaging revealed a 35x 49.5 mm aneurysm in the RCCA and critical stenosis of the LICA. A two-stage treatment approach was employed. Initially, a RoadsaverTM stent was successfully implanted in the LICA to reduce the risk of perioperative stroke. Subsequently, the right common carotid artery aneurysm was surgically resected and reconstructed using a GORE-TEX (R) graft. The procedure was completed without complications, and the patient had an uneventful recovery with no postoperative neurological deficits. This case underscores the importance of individualized treatment strategies for managing complex vascular pathologies. The use of surgical and endovascular techniques has been effective in treating both aneurysms and stenosis, highlighting the potential benefits of a multidisciplinary approach in these types of clinical cases.