Bilateral Cervical Internal Carotid Artery Pseudoaneurysms

A 67-year-old man who developed new-onset neurological symptoms was found to have bilateral internal carotid artery (ICA) pseudoaneurysms on computed tomography angiography. Pseudoaneurysms of the ICA are a rare diagnosis and can lead to significant morbidity and mortality including infarcts and, in some cases, hemorrhagic transformation of infarcts. The primary risk factors for the formation of ICA pseudoaneurysms are trauma and surgery. Other causes include infiltrating metastatic disease, infection, fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan syndrome, irradiation, and Behçet disease. Endovascular repair with stenting is a highly effective treatment option and preferred in patients with large symptomatic pseudoaneurysms. Depending on the etiology, open repair may be necessary. Individuals with smaller asymptomatic lesions are managed nonoperatively with antithrombotic therapy and are followed with serial imaging for significant changes in aneurysm size, which would necessitate procedural intervention.