An 86-year-old man presented with a headache and blurred vision. His surgical history was significant for an uneventful left sided CEA with a Vascular Patch (Synovis VG-0106N) and utilizing a Pruitt-Inahara Shunt during the procedure. This surgery was performed 2 months ago for high grade left internal carotid stenosis (90%). Patient was having no other associated symptoms and had no clinical signs of infection. Computed tomography (CT) angiography of the head and neck was then performed, revealing a 1.2 x 2.0 cm pseudoaneurysm with a small amount of surrounding thrombus within the distal left cervical internal carotid artery just proximal to the petrous portion (Figure 1). The PA was found to be distal to the endarterectomized area of the carotid artery which means that the defect was likely caused by the balloon portion of the shunt. A short segment of high grade stenosis (80%) was also revealed in the postbulbar region of the proximal left internal carotid artery (Figure 2). Patient was then taken to the catheterization lab for endovascular exclusion of the PA. The right groin was prepped, and a 6 French catheter was placed in the femoral artery. An internal mammary catheter was used and then selectively cannulated the internal mammary to gain access to the left carotid artery where angiography was performed. A 0.035 wire was then passed through, and a 7 French 9 cm long sheath was passed into the left common carotid artery where a repeat angiography was performed. Then a 0.014 BMW wire was passed across those lesions, and the position was confirmed. A 6 x 50 mm long covered Viabahn stent (W. L. Gore & Associates Inc., Flagstaff, AZ) was successfully deployed across the PA, but there were still the tight stenosis and 90-degree bend of the graft anastomosis of the endarterectomy site. For the residual stenosis, a 7 x 10 stent (Nitinol Acculink) was successfully deployed and expanded using a 5 Balloon to 6 Atmospheres (Figure 3). After full expansion was noted, the balloon was withdrawn, and completion angiography was performed confirming complete obliteration of the PA (Figure 4). Patient recovered with no postoperative neurological symptoms and had no complications upon 3-year followup.