Internal carotid artery aneurysms are rare pathologies. Endovascular treatment of these disorders is new and emerging field of interventional neurology. A 50 year old male presented to our unit with progressive headaches, visual disturbance and panhypopituitarism. Investigations revealed a giant fusiform right cavernous internal artery aneurysm (39 x 33 x 37 mm). He underwent endovascular treatment with a Surpass flow diverting stent and subsequently developed a cavernous sinus syndrome and carotid-venous fistula. A novel stent-in-stent technique was utilized and a Surpass Streamline 3 x 25 mm flow-diverting stent was placed across the fistulating zone of the initial stent, with clinical resolution of symptoms.
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