title: Pipeline embolization device and subsequent vessel sacrifice for treatment of a bleeding carotid pseudoaneurysm at the skull base: a case report.
abstract: An attempt at parent vessel reconstruction with Pipeline embolization devices to treat a mycotic pseudoaneurysm of the internal carotid artery at the skull base is presented. A 50-year-old woman with malignant otitis externa and bilateral temporal bone osteomyelitis presented with brisk bleeding from her left ear. She had bony dehiscence of the left carotid canal at CT and extravasation from a pseudoaneurysm of the carotid petrous segment at angiography. Carotid tortuosity proximally precluded placing a covered stent. After the lesion stopped bleeding spontaneously and given the presence of bilateral osteomyelitis putting the contralateral carotid at risk, the decision was made to attempt preservation of the parent vessel with flow diversion. However, bleeding recurred after 12 days, necessitating carotid sacrifice. This first reported experience in treating a carotid pseudoaneurysm at the skull base with the Pipeline device shows that transient cessation of bleeding is insufficient for flow diversion to be effective.
authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA. yasha.kadkhodayan@gmail.com
authors: Yasha
authors: Y
authors: Kadkhodayan
authors: Vilaas S
authors: VS
authors: Shetty
authors: Spiros L
authors: SL
authors: Blackburn
authors: Matthew R
authors: MR
authors: Reynolds
authors: DeWitte T
authors: DT
authors: Cross
authors: Christopher J
authors: CJ
authors: Moran
mesh_terms: D015901:Angiography, Digital Subtraction; D020212:Carotid Artery Injuries / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000628:therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000473:pathology; D010031:Otitis / Q000150:complications / Q000473:pathology; D019291:Skull Base / Q000473:pathology*; D013701:Temporal Bone / Q000473:pathology; D014057:Tomography, X-Ray Computed