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 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.
ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France mohamed.akkari.orl@gmail.com.
Mohamed
M
Akkari
Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France.
Grégory
G
Gascou
ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France.
Vincent
V
Trévillot
Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France.
Alain
A
Bonafé
ENT and Head and Neck Surgery Department, University Hospital Gui de Chauliac, University of Montpellier, France.
Louis
L
Crampette
Neuroradiology Department, University Hospital Gui de Chauliac, University of Montpellier, France.
Paolo
P
Machi
D000368:Aged; D015901:Angiography, Digital Subtraction; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D004844:Epistaxis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D018810:Magnetic Resonance Angiography; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015641:Radiography, Interventional; D013101:Sphenoid Sinus; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy
D010975:Platelet Aggregation Inhibitors
Epistaxis; cavernous internal carotid artery; endovascular management; flow diverter; non-traumatic aneurysm