Endovascular
stent placement for treatment of symptomatic
pseudoaneurysms in extracranial carotid arteries proved safe and effective. We aimed at increasing the efficacy of stenting for treatment of an internal carotid artery (ICA)
dissecting aneurysm by reducing the
stent porosity through placement of oversized overlapping
stents. A 55-year-old woman presented with right sided
hemiplegia and
aphasia. CT revealed an
infarction in the left hemisphere, and cerebral angiography showed an extracranial dissection of the left ICA with a 1.0 x 2.0 cm
pseudoaneurysm at the C1-level. Two oversized self-expandable
stents (8/30, 8/40 Wallstent) were placed, bridging the dissected segment and overlapping at the level of the aneurysmal neck. Immediate control angiography showed remarkably reduced filling of the
pseudoaneurysm. Intravascular flow assessment depicted a significant reduction of intraaneurysmal flow (31/0 cm/s). Follow-up arteriograms performed after six days and nine months confirmed complete disappearance of the
pseudoaneurysm and a patent vessel lumen. Reduced
stent porosity causes significant haemodynamic changes inside the aneurysmal sac and accelerates intraaneurysmal
thrombosis. Deployment of oversized and overlapping
stents may be helpful in achieving rapid complete occlusion and avoiding additional coil packing.