Mycotic internal carotid artery aneurysm: A literature review inspired by a case.

BackgroundMycotic aneurysms of the extracranial carotid artery are a rare consequence of localised or systemic infection. Typically caused by Staphylococcal infections, sequelae include further bacterial dissemination, stroke, rupture and death. Scarcely discussed in literature, the management of this pathology is limited to case reports and general consensus.MethodThe case of an internal carotid artery mycotic aneurysm in the setting of contralateral internal carotid artery occlusion managed with urgent endovascular repair is discussed. A systematic review was subsequently conducted according to PRISMA guidelines to further review the preferred management for this uncommon pathology.ResultA total of 38 articles discussing the clinical details of 48 mycotic ICA aneurysms in the adult population were reviewed. Similarly to the described case, the majority of infections were due to Staphylococcus species; however, contrary to the present case, most were managed with open repair. All cases were managed with antibiotic therapy.ConclusionWhilst most cases previously described in the literature have been managed with open bypass grafting, the present case describes an alternative treatment method with endovascular management in the emergent setting with good outcomes at 1-year post-stent placement.