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Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis

Abstract : 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.
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https://hal.umontpellier.fr/hal-01935925
Contributeur : Cécile Nowak <>
Soumis le : mardi 27 novembre 2018 - 10:42:15
Dernière modification le : vendredi 15 mai 2020 - 12:22:06

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Mohamed Akkari, Grégory Gascou, Vincent Trévillot, Alain Bonafe, Louis Crampette, et al.. Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis. Interventional Neuroradiology, Edizioni del Centauro, 2015, 21 (6), pp.660 - 663. ⟨10.1177/1591019915609164⟩. ⟨hal-01935925⟩

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