Extracranial Carotid Aneurysm in Takayasu Arteritis
A 15-year-old girl presented with dizziness and numbness of the left hand. Blood pressure was 212/82 mm Hg and 110/80 mm Hg in the right and left upper extremities. Physical examination revealed pulsatile overswelling of the right carotid artery and pulselessness of the left radial artery. Laboratory findings revealed elevated levels of C-reactive protein (7.4 mg/dL) and erythrocyte sedimentation rate (72 mm/h). A magnetic resonance angiogram of the neck revealed a fusiform aneurysmal dilation and concurrent stenosis in the left common carotid artery, dilation of brachiocephalic artery and right common carotid artery, and stenosis of left subclavian artery (Fig.). A computed tomography scan revealed thickened arterial walls of the aorta, brachiocephalic artery, and the branches of descending aorta. Takayasu arteritis was diagnosed. She was treated with high-dose oral prednisolone, antiplatelet agents, and antihypertensive agents and maintained on oral mycophenolate mofetil and tacrolimus, gradually weaning off prednisone. These medical treatments reduced the dilation of the aneurysm in the left common carotid artery.
Extracranial carotid aneurysm, a rare condition caused by Takayasu arteritis, tends to occur in the right carotid arteries but may occur in the left as well.1,2 Vascular wall inflammation causes damage to the elastic lamina and muscular media. Scarring compromises the vascular lumen and can cause aneurysmal dilation. Blood pressure may be closely associated with the dilation.3 An aggressive medical suppression of disease activity and proper control of hypertension are required. Aneurysms have a risk of rupture, even in the inactive phase. Careful observation is necessary to assess the need for urgent surgical intervention.