Parent Artery Occlusion for Pseudo-aneurysm in a Patient Presenting with Massive Epistaxis after Receiving Radiotherapy for Recurrent Nasopharyngeal Carcinoma: A Case Report

Abstract

A 37-year-old man was admitted to our institution for epistaxis after the additional radiotherapy for recurrent nasopharyngeal carcinoma. We embolized the feeding branches of the left artery with 33% n-butyl-2-cyanoacrylate(NBCA). About 30 minutes later, a subsequent massive epistaxis caused respiratory arrest and hemorrhagic shock. After we performed an emergency tracheostomy, the angiogram revealed a pseudo-aneurysm at the pyramidal segment of the left internal carotid artery (ICA). We determined that the collateral circulation was adequate, and performed parent artery occlusion of the left ICA including the aneurysm with 14 coils. Finally we injected 50% NBCA from inside the coils to the proximal ICA to occlude the parent artery completely. Two months later, we detected see-through coil masses in the left ICA in the nasal cavity, but no recurrence of epistaxis. We believe that NBCA injection may aid parent artery occlusion when treating a pseudo-aneurysm.