title: Delayed Endovascular Coil Extrusion following Internal Carotid Artery Embolization.
abstract: Internal carotid artery injury is a rare and devastating complication of endoscopic sinus and skull base surgery that has an associated mortality rate of 15%. This case describes a patient who developed massive epistaxis following routine sinus surgery and was eventually diagnosed with a pseudoaneurysm of the cavernous internal carotid artery. Endovascular coiling and Onyx (Covidien, Irvine, California, United States) liquid embolization were ultimately used to completely occlude the internal carotid artery with resolution of bleeding; however, the patient had an unexpected late complication of coil extrusion through the pseudoaneurysm sac into the sphenoid sinus and nasal cavity. The endoscopic skull base team safely excised the coils endoscopically without recurrent bleeding. We describe the multidisciplinary operative management of this case of endovascular coil extrusion to increase awareness of this potentially life-threatening complication.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dedmon
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Josh
authors.initials: J
authors.lastname: Meier
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Kyle
authors.initials: K
authors.lastname: Chambers
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Aaron
authors.initials: A
authors.lastname: Remenschneider
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Mehta
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Derrick
authors.initials: D
authors.lastname: Lin
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: William
authors.initials: W
authors.lastname: Curry
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, United States ; Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, United States.
authors.forename: Stacey
authors.initials: S
authors.lastname: Gray
keywords: endoscopic endonasal skull base surgery; endoscopic sinus surgery; endovascular embolization; internal carotid artery injury