Delayed Pipeline embolization of a ruptured true internal carotid artery aneurysm presenting with epistaxis: Case report and review of the literature.

Delayed Pipeline embolization of a ruptured true internal carotid artery aneurysm presenting with epistaxis: Case report and review of the literature.

World Neurosurg. 2019 Feb 01;:

Authors: Grandhi R, Brasiliense LBC, Williamson R, Zwagerman NT, Sauvageau E, Hanel RA

Abstract
BACKGROUND: Massive epistaxis from rupture of an intracavernous internal carotid artery (ICA) 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 due to a ruptured true cavernous ICA aneurysm. The patient was treated initially with coil embolization followed by placement of a Pipeline Embolization Device (PED). 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.

PMID: 30716493 [PubMed - as supplied by publisher]

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