Infected giant pseudoaneurysm of the extracranial internal carotid artery with vascular tortuosity: a case report

Extracranial carotid artery pseudoaneurysms (ECAPs) are rare. The etiologies of carotid artery pseudoaneurysms include wall degeneration, arterial wall damage during surgery, and infection. ECAPs can lead to severe complications, such as rupture, hemorrhage, cerebral ischemia due to thromboembolism, cerebral abscess, and airway obstruction. Endovascular treatment is recommended due to its advancements and the higher morbidity and mortality associated with surgical treatment. Herein, we report a case of a 76-year-old man with a history of coronavirus disease 2019 who was diagnosed with a fever of unknown origin. Carotid magnetic resonance angiography revealed a left proximal cervical internal carotid artery blowout with a large pseudoaneurysm. Although surgical treatment may be challenging when inflammatory structures adhere to aneurysm walls, open surgery remains an important therapeutic option. Therefore, aneurysmectomy and bypass grafting are alternative methods if endovascular treatment fails.