Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection

Objective: To evaluate the clinical course of aneurysms developed during ex tracranial internal carotid artery (ICA) dissection. Background: Aneurysms developed during extracranial ICA dissection are detected angiographically in 5 to 40% of cervical artery dissections. The clinical and radiologic cou rse of these aneurysms is not known, and it is not known how they should be treated. Methods: Fifty-eight consecutive patients with extracranial ICA d issection were reviewed, and those with radiographically detectable dissect ing aneurysm at the acute stage or during early follow-up were included in this study. All patients had regular clinical and MR angiography examinatio ns. Sixteen patients (27.5%) with a total of 20 ICA dissecting aneurysms we re followed for a mean period of 36.9 +/- 21 months (range, 10 to 93 months ). Results: No clinical symptoms suggestive of aneurysmal rupture or emboli zation from the aneurysm were identified. Extracranial ICA aneurysms remain ed unchanged in 65% of patients, were resolved in 5% of patients, and decre ased in size in 30% of patients. Conclusions: The clinical course of dissec ting aneurysms was benign, although spontaneous radiologic resolution occur red rarely. Medical management with antiplatelet therapy alone (after early anticoagulation) is generally sufficient, and surgical management was seld om required.