Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling

Abstract

Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature.

Intracranial Pseudoaneurysms: Evaluation and Management

“…Packing of the pseudoaneurysm with coils is available for those cases with a narrow neck pseudoaneurysm (52,71). Because of the fragility of the pseudoaneurysm wall, it has the risk of microcatheter or coil perforation during the procedure.…”

“…However, occlusion of the parent artery is not recommended for pseudoaneurysms of the ICA. Although having negative balloon occlusion test, 22% of patients develop ischemic complications following parent artery occlusion (Figure 3) (16,52,75).…”

“…Overlapping stents with coils effectively prevent rebleeding and regrowth of the pseudoaneurysm. The overlapping stents may divert the flow away from the pseudoaneurysm, accelerate intraaneurysmal thrombosis, and reconstruct the parent artery by promoting neointima formation along the stent (31,52,58,77). Another reconstructive endovascular treatment modality is covered stent implantation (2,59,78).…”

Treatment of Intracranial Pseudoaneurysms With a Novel Covered Stent: A Series of 19 Patients With Midterm Follow-Up

“…Severe epistaxis, unilateral loss of vision, and cranial base fracture have been reported as the typical triad signs for traumatic pseudoaneurysms (7). Delayed and repeated epistaxis after head and facial trauma is the distinctive manifestation in most cases (6,8,20,22,27). However, in our series, only two patients (10.5%, 2/19) initially presented with epistaxis, and the majority (89.5%, 17/19) of patients presented vision loss as their chief complaint.…”

“…Other clinical manifestations include unilateral vision loss, cerebral ischemia, or compressive effect. Although computed tomography (CT) and magnetic resonance imaging can provide valuable indications (8), digital subtraction angiography (DSA) remains the gold standard for diagnosis (6).…”