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

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...

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Bibliographic Details
Published in:Interventional neuroradiology 2015-12, Vol.21 (6), p.660-663
Main Authors: Akkari, Mohamed, Gascou, Grégory, Trévillot, Vincent, Bonafé, Alain, Crampette, Louis, Machi, Paolo
Format: Article
Language:English
Subjects:
Aged
Aneurysm
Angiography, Digital Subtraction
Bioengineering
Carotid Artery Diseases - complications
Carotid Artery Diseases - diagnostic imaging
Carotid Artery Diseases - therapy
Cerebral Angiography
Cognitive science
Embolization, Therapeutic - methods
Epistaxis - diagnostic imaging
Epistaxis - etiology
Epistaxis - therapy
Female
Hematoma - diagnostic imaging
Hematoma - etiology
Hematoma - therapy
Human health and pathology
Humans
Imaging
Life Sciences
Magnetic Resonance Angiography
Neuroscience
Nuclear medicine
Platelet Aggregation Inhibitors - therapeutic use
Radiography, Interventional
Sphenoid Sinus
Stents
Subarachnoid Hemorrhage - diagnostic imaging
Subarachnoid Hemorrhage - etiology
Subarachnoid Hemorrhage - therapy
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Summary: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.
ISSN:1591-0199
2385-2011
DOI:10.1177/1591019915609164