Abstract
Objective
Pseudoaneurysm formation after carotid artery stenting (CAS) is a rare but potentially life-threatening complication. Herein, we report a case of delayed pseudoaneurysm formation associated with a heavily calcified lesion and discuss the possible underlying mechanisms.Case presentation
An 87-year-old man presented with symptomatic left carotid artery stenosis. Carotid ultrasonography demonstrated a heavily calcified plaque without marked flow acceleration, and DSA revealed 69% stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. CAS was performed without any immediate complications. One month after the procedure, the patient developed a progressive swelling in the left cervical region. Ultrasonography and DSA revealed a pseudoaneurysm at the proximal edge of the stent accompanied by stent shortening. The lesion enlarged rapidly and caused tracheal compression, necessitating urgent intervention. Stent-assisted coil embolization was then performed. Although complete obliteration was not achieved, residual flow with marked stagnation was observed, and the cervical swelling gradually improved.Conclusion
Mechanical stress caused by balloon dilation of heavily calcified plaques may lead to arterial-wall injury and subsequent pseudoaneurysm formation. Rigorous monitoring is crucial when performing CAS for severely calcified lesions.