A 55-year old woman was incidentally found to have a proximal internal carotid aneurysm.  After a discussion of the treatment options she elected to undergo coil embolization.  During the procedure the neck of the aneurysm was noted to be wider than previously thought and this precluded stable deployment of the coil loops.  The procedure was aborted and after further discussion, we decided to proceed at a later date with a two-stage stent-coil procedure.  At the first stage we deployed a stent across the base of the wide-necked aneurysm.  she later returned for coil deployment resulting in 100% occlusion (see accompanying figures).
 

A 62-year old man presented with a history of multiple strokes and progressive TIAs despite maximal medical therapy.  He eventually required pressors in a recumbent position to prevent a recurrent dense right hemiparesis.  An arteriogram showed a completely occluded right internal carotid artery near its origin.  It also showed minimal cross-flow from the right ICA injection to the left hemisphere via a stenotic anterior communicating artery.  His left superficial temporal artery was very small.  A cervical to supraclinoid ICA saphenous vein bypass was performed with good perfusion to the left hemisphere.