Two Cases of Carotid Artery Stenting Combined Balloon- and Self-expanding Stent for the Spontaneous Internal Carotid Artery Dissections

Objective: Although conservative treatment is the first choice for high cervical internal carotid artery (ICA) stenosis due to spontaneous cervical ICA dissection, surgical revascularization is necessary when the disease resists conservative treatment. Although such lesions are difficult to treat by conventional carotid endarterectomy (CEA) or carotid artery stenting (CAS), they may be treated less invasively by modified CAS with add-on devices. In this report, we present two cases of CAS performed by the combined use of balloonand self-expanding stents with a review of the literature. Case Presentations: Revascularization was performed by the same procedure in a 47-year-old man and a 43-year-old woman with left high cervical ICA stenosis. In the first case, no restenosis was noted on follow-up DSA performed after 1 year, but the self-expanding stent that initially overlapped the balloon-expandable stent had slipped off. Conclusion: High cervical carotid artery stenosis due to spontaneous cervical ICA dissection can be treated by CAS using the proximal protection technique with the combined use of a balloon-expandable stent.