Incidental neck mass in a young adult: A case report

Introduction: While true extracranial internal carotid aneurysms (tECAAs) are extremely rare and often asymptomatic, they can lead to serious complications including rupture, thrombosis or embolization. Surgery has been the standard, even in asymptomatic patients, due to safety and long-term outcomes. However, advancements in technology have introduced endovascular interventions and observation as options.

Presentation of case: A 32-year-old obese man presented with sudden right-sided facial numbness lasting 3 h. Personal, family, social and trauma history were unremarkable. Cardiac and neurological examinations were normal. Imaging revealed a non-flow-limiting stenosis and a left internal carotid saccular artery aneurysm (15 × 16 mm). After considering the pros and cons of each treatment and thorough shared decision-making, left carotid stenting (6 × 25 mm ViabahnGORE) was performed. The postoperative course was uneventful. Patient was discharged on the postoperative day 2 with Clopidogrel.

Discussion: The choice of treatment approach for tECAAs depends on various factors, including patient characteristics, surgeon experience, and equipment availability. In general, symptomatic aneurysms (regardless of diameter), expanding aneurysms, and larger aneurysms (>20 mm), and those with identified thrombus are typically indications for repair.

Conclusion: Endovascular techniques are gaining traction due to their potential advantages, including avoidance of cranial nerve injury and general anesthesia, enhanced access and control of lesions that may be difficult to navigate surgically, and lower rates of perioperative morbidity and mortality.