An old dissecting aneurysm of the internal carotid artery presenting as acute stroke

In carotid artery dissections, local and ischemic manifestations usually occur within days or weeks. In some cases, persistent extracranial aneurysms cause thromboembolic complications even years after the initial event. The management of these aneurysms is still controversial. We report the case of a 74 year old woman with a stroke due to a long standing giant dissecting aneurysm of the internal carotid artery. Medical management was insufficient to stop ongoing embolization. She was finally successfully treated with stenting. Carotid artery aneurysms can become symptomatic even after many years of silence. Once medical therapy fails, endovascular treatment can avoid recurrent embolization.