Pseudo-aneurysm Associated with Endovascular Re-canalization for Internal Carotid Artery Occlusion

Internal carotid artery occlusion (ICAO) is a relative uncommon but important cause of transient ischemic attack (TIA) and cerebral infarction. The feasibility of endovascular re-canalization has been reported in a recent article. In the present report, we describe a 77-year-old man who received endovascular re-canalization of right ICAO. His clinical symptoms recurred 4 months after the procedure, and follow-up perfusion computed tomography (CT) revealed right hemisphere ischemia. Repeat carotid angiogram showed a large pseudo-aneurysm with narrowed true lumen in the distal cervical carotid artery, most likely resulted from previous re-canalization procedure. A coronary stent was deployed to re-establish patency of the vessel, covering and jailing the orifice of the pseudo-aneurysm. Late pseudo-aneurysm formation should be considered as a potential complication after endovascular re-canalization of ICAO.