Patient aged 45 years assessed in September 2000 for left hemiparesis. His medical history included smoking, hypertension, hypercholesterolemia, peritonitis at the age of 18 and myocardial infarction in 1999. After CT and MRI, cerebral angiography diagnosed occlusion of the right internal carotid artery and 60% stenosis associated with pseudoaneurysm in the cervical tract of the left, with signs of dissection on MRI.

Contralateral supply was found to be present. Using the right common femoral approach, a monorail metallic stent (Carotid wallstent, Boston Scientific Co.) was implanted in the area of the stenosis that also extended over the pseudoaneurysmal area of the cervical course of the left internal carotid artery.

A microcatheter was introduced through the stent mesh and GDC coils (Boston Scientific Co.) were released without risk of migration.
A post-procedural angiographic control showed the recovery of the lumen in the stenotic zone and the absence of filling of the pseudoaneurysm. During the procedure, 5000 IU of sodium heparin was administered. Sequential anticoagulation therapy was performed in the acute phase with sodium heparin in continuous perfusion, followed by dicoumarinics and, subsequently, antiplatelet agents.

After three years of evolution, angiographic and echographic controls showed patency of the treated artery without recurrence of the pseudoaneurysm; the patient has not presented neurological symptoms in the left carotid territory.