Internal carotid artery aneurysm with life-threatening hemorrhages in a pediatric patient: endovascular treatment options.
OBJECTIVE
To describe the management of a pediatric patient with recurrent, life-threatening nasopharyngeal hemorrhages due to a pseudoaneurysm of the internal carotid artery (ICA), most likely caused by deep neck infection following peritonsillar abscess.


METHODS
An 11-year-old boy presented with lymphadenopathy of the neck, torticollis, and difficulty swallowing that had persisted for some weeks. After sneezing, the patient suffered massive recurrent nasopharyngeal hemorrhages leading to anemia. Computed tomography identified a 2 x 2-cm hematoma in the left parapharyngeal space; angiography revealed a saccular aneurysm (14.1 x 8.2 mm) of the extracranial ICA adjacent to the skull base, without ongoing hemorrhage. A bare Wallstent was initially implanted, but total exclusion was achieved only after secondary placement of a Symbiot covered stent within the bare stent.


CONCLUSIONS
This case demonstrates the utility of an endovascular approach to an extracranial ICA pseudoaneurysm in a pediatric patient.
Gralla
Jan
J
Department of Neuroradiology, University of Bern, Switzerland. jan.gralla@insel.ch
Brekenfeld
Caspar
C
Schmidli
Juerg
J
Caversaccio
Marco
M
Do
Dai-Do
DD
Schroth
Gerhard
G
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000800:Angioplasty, Balloon / Q000379:methods*; D002343:Carotid Artery, Internal; D002533:Cerebral Angiography; D002648:Child; D016638:Critical Illness; D004638:Emergency Treatment / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000628:therapy*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome