Journal of neuroendovascular therapy · 2026
Delayed Pseudoaneurysm Formation after Carotid Artery Stenting in a Heavily Calcified Lesion: A Possible Mechanism of Mechanical Vessel Injury.
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Kisanuki Tomomi, Nagano Yushi, Makino Ryutaro, Sugata Jun, Higashi Takuichiro, Tanaka Shunichi, Yamahata Hitoshi, Hanaya Ryosuke
Аннотация
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.
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.