A Recurred Carotid Siphon Pseudoaneurysm after Detachable Coil Embolization

Abstract

Massive posterior epistaxis is one of the peculiar symptoms of pseudoaneurysms of the carotid siphon. We experienced a case of trauma-related pseudoaneurysm of the carotid siphon. The lesion was initially silent except for the mass effect. We initially treated the lesion with platinum detachable coil embolization of the pseudoaneurysm sac with preservation of the parent artery. However, the patient had delayed massive epistaxis with recurrence of the pseudoaneurysm. The patient was subsequently managed with endovascular occlusion of the affected internal carotid artery using detachable balloons. Complete internal carotid artery trapping is recommended as an initial treatment modality if the patient can tolerate to the occlusion test. Careful observation and follow-up of the patient is required if the lesion is inevitably managed with coil embolization of the pseudoaneurysm sac alone.

Keywords

Carotid arteries aneurysm injuries therapeutic blockade therapy

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References

Maurer

Mills

German

: Triad of unilateral blindness, orbital fracture and massive epistaxis in head injury. J Neurosurg 18: 837–846, 1961.

Shirai

Tomono

: Traumatic aneurysm of the internal carotid artery. Eur Neurol 15: 212–216, 1977.

Goleas

Mikhael

: Intracavernous carotid artery aneurysm presenting as recurrent epistaxis. Ann Otol Rhinol Laryngol 100: 577–579, 1991.

Bhatoe

Suryanarayana

Gill

: Recurrent massive epistaxis due to traumatic intracavernous internal carotid artery aneurysm. J Laryngol Otol 109: 650–652, 1995.

Simpson

Harper

Bryan

: Emergency balloon occlusion for massive epistaxis due to traumatic carotid-cavernous aneurysm. J Neurosurg 68: 142–144, 1988.

Williams

Traquina

: Coil embolization of a ruptured carotid pseudoaneurysm presenting as epistaxis — pediatric otolaryngology: principles and practice. Am J Otolaryngol 21: 38–42, 2000.

Chen

Concus

: Epistaxis originating from traumatic pseudoaneurysm of the internal carotid artery: diagnosis and endovascular therapy. Laryngoscope 108: 326–331, 1998.

Chae

S-W

Choi

: Intrasaccular detachable platinum coil embolization for traumatic pseudoaneurysm treatment of a cavernous carotid artery. Otolaryngol Head Neck Surg 124: 230–231, 2001.

Teitelbaum

Halbach

: Treatment of massive posterior epistaxis by detachable coil embolization of a cavernous internal carotid artery aneurysm. Neuroradiology 37: 334–336, 1995.