Delayed Pipeline Embolization of a Ruptured True Internal Carotid Artery Aneurysm Presenting with Epistaxis: Case Report and Review of the Literature.

Document Type

Article

Abstract

BACKGROUND: Massive epistaxis from rupture of an intracavernous internal carotid artery aneurysm is a potentially fatal event. Although rare, this presentation is seen most often in patients after trauma or iatrogenic injury secondary to transsphenoidal surgery or radiation therapy.

CASE DESCRIPTION: We present our unusual case of a patient with no significant risk factors who had recurrent epistaxis owing to a ruptured true cavernous internal carotid artery aneurysm. The patient was treated initially with coil embolization followed by placement of a Pipeline embolization device. The patient had complete resolution of her bleeding events. A follow-up arteriogram performed 14 months later confirmed aneurysm obliteration, with parent artery preservation and no evidence of in-stent stenosis.

CONCLUSIONS: Our case highlights the importance of evaluating for intracranial pathological conditions in patients who present with refractory epistaxis. In selected patients, the use of flow-diversion technology as an adjunct or alternative to primary coil embolization for treatment should be considered.

Medical Subject Headings

Carotid Artery Diseases; Carotid Artery, Internal; Embolization, Therapeutic; Epistaxis; Female; Humans; Middle Aged; Platelet Aggregation Inhibitors; Self Expandable Metallic Stents; Time-to-Treatment

Publication Date

5-1-2019

Publication Title

World Neurosurg

ISSN

1878-8769

Volume

125

First Page

273

Last Page

276

PubMed ID

30716493

Digital Object Identifier (DOI)

10.1016/j.wneu.2019.01.126

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