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Interv Neuroradiol. 2015 Dec;21(6):660-3. doi: 10.1177/1591019915609164. Epub 2015 Oct 22.

Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis.

Author information

1
ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France mohamed.akkari.orl@gmail.com.
2
Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France.
3
ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France.

Abstract

Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.

KEYWORDS:

Epistaxis; cavernous internal carotid artery; endovascular management; flow diverter; non-traumatic aneurysm

PMID:
26494406
PMCID:
PMC4757345
DOI:
10.1177/1591019915609164
[Indexed for MEDLINE]
Free PMC Article

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