We report a 56-year-old man with recurrent ischemic strokes due to a right carotid web unresponsive to conservative management. He underwent elective right internal carotid artery stenting with an open-cell stent without complications. Four months later, he presented with a pulsatile right-sided neck mass, diagnosed as a common carotid artery pseudoaneurysm at the proximal stent margin. His hospital course was complicated by methicillin-susceptible Staphylococcus aureus bacteremia treated by intravenous antibiotics, but an extensive workup excluded an infectious role in pseudoaneurysm formation. The lesion was treated with a balloon-expandable covered stent, achieving exclusion from circulation and thrombosis, exhibiting durable clinical and radiographic resolution. Connective tissue genetic testing is pending.

Carotid artery pseudoaneurysm is a rare complication of stenting with diverse etiologies, including infection, connective tissue disorders, and prior radiation. Optimal management is individualized, integrating clinical presentation, neurological risk, and vascular anatomy. Both surgical and endovascular strategies can achieve favorable outcomes when tailored to patient-specific factors.