Procedural outcomes and follow-up of endovascular treatment for extracranial carotid artery aneurysms; a systematic review

BACKGROUND AND PURPOSE: Extracranial carotid artery aneurysms (ECAAs) are a rare vascular disorder for which no standardised treatment guidelines exist. Endovascular treatment (EVT) has become an alternative to open repair, but comprehensive evaluation of its outcomes is lacking. METHODS: A systematic review was performed according to PRISMA guidelines and registered in PROSPERO (CRD420250577498). MEDLINE, EMBASE, and Cochrane Library were searched from inception to August 2025 for studies including ≥10 patients treated with EVT for ECAA. Study characteristics, procedural outcomes, and follow-up results were extracted. Methodological quality was assessed using a modified Joanna Briggs Institute (JBI) Critical Appraisal tool. RESULTS: Fourteen observational studies including 276 patients with 295 aneurysms were identified. The technical success rate was 98.6%, with complete aneurysm exclusion in 87.3%. Periprocedural stroke occurred in 2.5% and procedure related mortality in 0.4%. During a median follow-up of 16.6 months, mid-term patency was 93.9%, and reintervention was performed in 3.2% of cases. Outcomes were comparable across stent types. Quality assessment revealed moderate to high risk of bias across most studies due to heterogeneity in design, definitions, and follow-up duration. CONCLUSION: Endovascular treatment of ECAA appears to be technically feasible and safe, offering high technical success and low complication rates. The available evidence however remains limited by small, heterogeneous studies with short follow-up. Standardised outcome reporting and multicentre prospective research are needed to define long-term durability and guide future clinical management.