Massive epistaxis related to petrous carotid artery pseudoaneurysm after radiation therapy: emergency treatment with covered stent in two cases

Abstract

Two patients had acute left carotid rupture from radiation therapy-induced pseudoaneurysms, resulting in hemodynamic collapse. Because the patients were semicomatose and in shock, an immediate salvage procedure was needed. Location of the pseudoaneurysm at the skull base made surgical treatment less possible. Endovascular therapy was the treatment of choice. Preserving patency of the carotid artery was a desirable option. The successful use of a covered stent in the emergency treatment of massive epistaxis due to active bleeding from pseudoaneurysm in the petrous internal carotid artery (ICA) is described.

Fig 1.

Case 1. A, Conventional angiogram shows a small pseudoaneurysm in the distal portion of the left ICA. The pseudoaneurysm points inferomedially. B, Follow-up angiogram after stent placement depicts patency of the artery, with no evidence of pseudoaneurym

Fig 2.

Case 2. A, Conventional angiogram with left ICA injection demonstrates a large pseudoaneurysm in the petrous portion of the ICA. B, Follow-up angiogram after stent placement shows total isolation of the pseudoaneurysm and patency of the ICA

Fig 3.

Case 2 (3-month follow-up). A, Follow-up oblique sagittal reformation of a CT angiogram of the neck depicts patency of the portion of the left ICA with stent, with no evidence of pseudoaneurysm. B, Follow-up axial CT scan shows that some portion of the ICA with stent is exposed to the nasopharynx.