Combination of stenting and coil embolization for carotid artery pseudoaneurysm causing symptomatic mass effect: case report

A case of cervical pseudoaneurysm secondary to carotid artery dissection causing symptomatic mass effect was reported. A 60-year-old woman presented with the complaint of right neck swelling and dysphagia that was considered to be the mass effect of a pseudoaneurysm caused by dissection of the right common carotid artery (CCA). Although a self-expanding stent was deployed to cover the orifice of the pseudoaneurysm, the pseudoaneurysm had been enlarged because of thrombus formation on the inner wall. A microcatheter was guided through the stent mesh into the aneurysm, and Guglielmi detachable coils were placed to embolize the orifice. One month later, angiography revealed complete embolization of the aneurysm while preserving flow in the CCA. The mass effect attributable to the pseudoaneurysm was relieved symptomatically as well as radiologically. Carotid artery dissection with symptomatic mass effect can be treated successfully, using a combination of stent and coils. This method may be considered to be an alternative to conventional surgical treatment such as proximal ligation, extracranial-intracranial bypass, or direct surgical repair.