Covered stent placement for the treatment of mycotic extracranial carotid artery aneurysm: a case report and comprehensive review

Extracranial carotid artery aneurysms (ECAAs) are rare, and mycotic aneurysms are even rarer. Here, we report a case of a giant extracranial carotid artery mycotic aneurysm treated successfully with a covered stent. A 78-year-old man with no pertinent medical history other than a history of acute cholangitis 2 months previously presented with a huge expansile, pulsatile, and non-tender mass in the right neck. Cerebral angiography revealed a right ECAA measuring 35.3×27.5 mm involving the bifurcation of the right common carotid artery. Endovascular reconstruction of the right carotid artery using a vascular-covered stent was performed. After treatment, the ECAA was occluded, and the patient had no new neurological symptoms. The patient underwent a concurrent 2-week course of antibiotic therapy, and the masses regressed entirely. Endovascular treatment with a covered stent, along with appropriate antibiotics, is a feasible and safe option for treating mycotic aneurysms involving the carotid bifurcation.