ENDOVASCULAR TREATMENT OF LIFE THREATENING EPISTAXIS SECONDARY TO INTERNAL CAROTID ARTERY (ICA) PATHOLOGIESu2013 AN INSTITUTIONAL EXPERIENCE

• Main Author: Gupta, Madanmohan
• Format: Web Resource
• Language: English
• Published: Morressier 01.01.2017
• DOI: 10.26226/morressier.5cb58cfcc668520010b56cb4

Background and Aims: Massive epistaxis can occur from internal carotid artery pathologies, especially involving its cavernous segment. Endovascular methods are crucial for their management. We intend to analyse our cases for angiographic features, management and outcome. Methods: We retrospectively analysed clinical and imaging records of 19 patients who presented to our Institution with severe epistaxis and were treated be endovascular means, during 2010 to 2018. Results: All our patients except one were male and were aged between 19 and 72 years. Eleven patients had history of road traffic accident, 6 iatrogenic injury during skull base surgery and 2 had spontaneous rupture of cavernous ICA aneurysms. Eight had associated carotico-cavernous fistula (CCF). All had involvement of cavernous segment of ICA with most of them (13) located at the anterior genu. All were managed endovascularly. Six were managed by coiling of the pseudoaneurysm with parent vessel preservation , 5 by detachable balloons, 3 by stent graft and one by trans-venous coiling of sac while 3 patients were treated by coiling with parent vessel occlusion. Collateral/ Cross flow study done in all 19 patients showed patent cross flow in 17. None of our patients showed recurrence of symptoms during a mean follow up of 12 months. One patient, treated with detachable balloon showed asymptomatic residual aneurym, later treated by stent assisted coiling. One patient presented with recurrent epistaxis after 2 weeks due to deflation of balloon, which was then treated with parent artery occlusion. Conclusions: Epistaxis due to cavernous ICA pathologies can be effectively treated by endovascular means.