Carotid Endarterectomy in Patients with Cerebral Aneurysms

Objectives: To present the results of carotid endarterectomy (CEA) in patients with intracranial aneurysm (IA), and evaluate the risk of postoperative hemorrhage due to IA rupture. Materials and Methods: Between January 2008 and December 2015, all patients treated with primary single sided CEA for extracranial asymptomatic severe carotid artery stenosis or symptomatic lesions were identified. Preoperatively, all patients underwent computed tomography angiography (CTA). Immediate neurologic assessment of the patient was accomplished upon completion of the intervention. In these patients, CT-A was performed at the 1 year follow-up to assess the characteristics of the IA. Results: Out of 526 patients who underwent CEA during the study period, 13 (2.2%) were identified to have an extracranial carotid artery stenosis with an IA. There were 7 (54%) males; mean age was 68 ± 9 years (range, 52- 85; IQR, 61-73). Urgent CEA was performed in 4 (31%) cases. Postoperative cerebrovascular complication rate was 15% (n = 2): non disabling minor stroke (n = 1), and intracranial hemorrhage (n = 1). Rupture of the IA never occurred. In-hospital mortality rate was 8% (n = 1, the abovementioned hemorrhage). All but 12 (92%) patients were discharge alive and independent. At 1 year followup, no patient with tandem lesion died: all of them underwent CT-A control, and IA rupture was never detected. Conclusions: Authors experience is consistent with the most recent Literature analysis which suggests that CEA does not significantly increases the risk of IA rupture.