Dissection of the internal carotid artery is an under-recognized cause of transient ischemic attack and cerebral vascular accident. Spontaneous dissections, in which no precipitating cause can be identified, occur infrequently. Endovascular intervention is an evolving treatment option in patients in whom anticoagulation therapy alone is not adequate, who are not suitable candidates for major surgery, or who have extremely distal dissections that are difficult to access. We report a case of successful endovascular stenting and coil application in a patient with spontaneous dissection of the distal cervical internal carotid artery with extension to its petrous portion and an accompanying pseudoaneurysm at the level of the skull base.