Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect

BACKGROUND Carotid artery dissection manifesting with symptomatic mass effe ct has been treated surgically according to the previous literature. Recent ly, some cases of carotid artery dissection manifesting with ischemic sympt oms were treated successfully with endovascular insertion of coils after st enting. METHODS A 42-year-old man with spontaneous dissection of the left cervical internal carotid artery (ICA) presented with the major complaint of left ne ck swelling and pain that was considered to be the mass effect of a pseudoa neurysm caused by dissection of the ICA. Endovascular therapy using a stent and coils was performed. The self-expanding stent was deployed to cover th e neck of the pseudoaneurysm. A microcatheter was then guided through the s tent mesh into the aneurysm, and coils were placed to pack it. RESULTS Four months later, angiography revealed complete embolization of th e aneurysm with preserved flow in the ICA. The mass effect attributable to the pseudoaneurysm was relieved symptomatically as well as radiologically. CONCLUSION Cervical artery dissection with symptomatic mass effect can be t reated successfully by the combination of stent and coils. This may be cons idered as an alternative to conventional proximal ligation, extracranial-in tracranial bypass, or direct surgical repair. (C) 2000 by Elsevier Science Inc.