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Giant cell arteritis as a cause of extracranial internal carotid artery aneurysm: a case report

Summary

A 57-year-old woman was found to have a balloon-like bulge (pseudoaneurysm) in her carotid artery in the neck. Doctors performed surgery to remove the bulge and reconnect the artery. When they examined the removed tissue under a microscope, they discovered it was caused by giant cell arteritis, a rare inflammatory disease that affects blood vessels. After surgery, the patient recovered well with normal blood flow restored to the artery, and doctors recommend this open surgery approach as the best way to treat this condition.

Background

Extracranial carotid artery aneurysms (ECAA) are rare vascular diseases with an incidence of 0.4-4.0% among all peripheral arterial aneurysms. Giant cell arteritis (GCA) is a systemic granulomatous vasculitis that can affect large- and medium-sized arteries, though aneurysm formation is extremely rare. This case presents an unusual presentation of GCA manifesting as an extracranial internal carotid artery pseudoaneurysm.

Objective

To report the management and diagnosis of a patient with extracranial internal carotid artery pseudoaneurysm caused by giant cell arteritis and to highlight the advantages of open surgical treatment in defining rare etiologies.

Results

Duplex ultrasonography revealed a saccular aneurysm of the left common carotid artery bifurcation (16.0 mm diameter) with thrombosis. CT angiography showed a mushroom-shaped pseudoaneurysm (11.0 × 6.0 mm) on the posterolateral wall of the left internal carotid artery bulb. Surgical resection was successfully performed with normal blood flow restoration and uncomplicated postoperative recovery. Histopathological examination confirmed giant cell arteritis with inflammatory infiltrate composed of lymphocytes, macrophages, and giant multinucleated cells.

Conclusion

Open surgical treatment of extracranial carotid artery aneurysms is highly effective and allows optimal arterial reconstruction while defining rare etiologies such as giant cell arteritis. The used reconstruction technique successfully prevented dissection, restenosis, and anastomotic aneurysm formation during long-term follow-up. This case emphasizes the importance of histopathological examination in identifying underlying vasculitis in rare cases of carotid artery aneurysms.
  • Published in:Journal of Medical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39187906, DOI: 10.1186/s13256-024-04673-2
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