Doubled stenting for effective occlusion of a dissecting carotid artery aneurysm

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.