OPEN VERSUS ENDOVASCULAR REPAIR FOR EXTRACRANIAL CAROTID ANEURYSMS.

INTRODUCTION ExtraCranial Carotid artery Aneurysms (ECCAs) are rare, although they are associated with a high stroke and mortality risk if untreated. This review aims to compare major outcomes between open and endovascular repair of ECCAs. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for clinical studies published online up to September 2020 that evaluated major outcomes after both open and endovascular repair of ECCAs. Eligible studies should evaluate at least 30-day mortality or stroke/TIA (transient ischemic attack) rates. Quality of studies was also evaluated. RESULTS Overall, seven studies (3 of high, 2 of medium and 2 of low quality) including 374 patients with 383 ECCAs were eligible. All studies were published from 2004 to 2020. In total, 220 open repairs were compared with 81 endovascular repairs. Open and endovascular treatments showed similar 30-day mortality rates (4% versus 0%; pooled OR 2.67 [95% CI = .291- 24.451]) and stroke/TIA rates (5.5% versus 1.2%; pooled OR 1.42 [95% CI = .412 - 4.886]). Open repair was associated in 6 studies with higher cranial nerve injury compared to endovascular repair (14.5% versus 0%; OR 3.98 [95% CI = 1.178 - 13.471]). Hematoma/bleeding rate was also similar between the two methods among 6 studies (5.2% versus 0%; OR 1.92 [95% CI = .518 - 7.094]). CONCLUSIONS Open and endovascular repair of ECCAs are associated with similarly low early mortality and cerebrovascular event rates although open repair shows a higher risk for cranial nerve injuries. Endovascular approach could be more appropriate when aneurysm is distally located or needs extensive dissection. More studies are needed with standardized follow-up duration to evaluate late outcomes as well.