Surgical Iatrogenic Internal Carotid Artery Injury Treated with Pipeline Embolization Device: Case Report and Review of the Literature

• Published in: Journal of Neuroendovascular Therapy 2017, Vol.11(12), pp.640-646
• Main Authors: Tamura, Takamitsu, Rex, David E., Puri, Ajit S., Wakhloo, Ajay K.
• Format: Article
• Language: English
• Subjects: flow diverter; neurosurgery; parent artery preservation; pseudo-aneurysm; surgical iatrogenic internal carotid artery injury
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.cr.2017-0058

Objective: Case reports in regard of using Pipeline Embolization Devices (PED): endoluminal reconstruction device for treatment of iatrogenic internal carotid artery (ICA) injury is still rare. We describe a successfully treated case of surgical iatrogenic ICA injury by double overlapped PEDs placement.Case Presentation: A 79-year-old female underwent endoscopic trans-nasal aspiration for chronic sphenoid and ethmoid sinusitis. This surgery was complicated by brisk arterial bleeding developed along the right lateral wall in the sphenoid sinus. There was a concern that the bleed could related to a tear in the cavernous segment of the right ICA. Immediate angiogram showed a small pseudo-aneurysm appearance, corresponding with the injured site. The pseudo-aneurysm spontaneously disappeared, however, owing to recurrence of arterial nasal bleeding of upon nasal packing removal, double overlapped PEDs were successfully placed in the right ICA cavernous/supraclinoid segment. Immediate cessation of bleeding was achieved and packing could be removed.Conclusion: The use of PED for surgical iatrogenic ICA injury appears to be a rational therapeutic alternative with preservation of the parent artery blood flow.