Management of patients with symptomatic extracranial carotid artery disease and incidental intracranial berry aneurysm

Paul M. Orecchia*, George Patrick Clagett, Jerry R. Youkey, Robert A. Brigham, Daniel F. Fisher, Richard F. Fry, Paul T. McDonald, George J. Collins, Norman M. Rich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Perioperative fluctuation of blood pressure and the use of anticoagulants during carotid endarterectomy may potentiate lethal aneurysm rupture in patients who have symptomatic extracranial carotid artery occlusive disease with incidental, asymptomatic, intracranial berry aneurysms. Ten patients having this combination are described in the present study. Of five men and five women whose mean age was 63 years, nine had symptomatic carotid bifurcation atherosclerosis, one had internal carotid fibromuscular dysplasia, and all had intracranial berry aneurysms ranging from 2 to 13 mm in diameter (mean diameter 6.6 mm). In seven patients, aneurysms were ≥6 mm in diameter. Hypertension was present in seven patients and moderately severe in five. Three of the aneurysms were located in the intracranial internal carotid artery, five in the middle cerebral artery, three in the posterior communicating artery, one in the anterior cerebral artery, and one in the superior cerebellar artery. Twelve carotid reconstructive procedures were performed without morbidity related to aneurysm rupture. These included 10 carotid endarterectomies, one of which was combined with Dacron patch angioplasty and one of which was combined with a simultaneous coronary artery bypass; one carotid artery dilatation for fibromuscular disease; and one reoperative carotid endarterectomy with patch angioplasty. Three patients had correction of hemodynamically significant lesions, two of which were proximal to ipsilateral anterior circulation aneurysms. An intraluminal shunt and heparin anticoagulation therapy were used in all patients. Despite a concerted effort to control blood pressure, the patients' perioperative blood pressures ranged from 60/30 to 240/110 mm Hg. Three patients had subsequent elective clipping of intracranial aneurysms. The results of this study indicate that carotid endarterectomy is safe in patients with asympatomatic intracranial aneurysms <10 mm in diameter. In patients with larger aneurysms, prophylactic aneurysm repair prior to carotid surgery should be considered but is not of proven benefit.

Original languageEnglish
Pages (from-to)158-164
Number of pages7
JournalJournal of Vascular Surgery
Issue number1
StatePublished - Jan 1985
Externally publishedYes


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