Endovascular management of life-threatening epistaxis from cavernous internal carotid artery lesions: an...

Massive epistaxis due to cavernous internal carotid artery (cICA) pathology is a life-threatening condition. The most common causes are craniofacial trauma and, rarely, spontaneous rupture of cICA aneurysms. While surgical management of cICA aneurysm is often challenging, endovascular methods offer a more straightforward and more reliable solutions. This article shares our institutional experience in the endovascular management of these grave pathologies and their long-term outcome.

We retrospectively identified 20 patients who presented with recurrent or massive epistaxis due to internal carotid artery pathologies (aneurysm/CCF). In our department, they were treated using endovascular methods. The outcome of the endovascular treatment was assessed based on the resolution of symptoms and the angiographic obliteration of ICA pathologies.

Of the 20 patients in the study, 19 were male, and the mean age was 33.1 years (ranging from 19 to 72 years). The most common cause for epistaxis was craniofacial trauma due to road traffic accidents (RTA) (n = 14). Besides epistaxis, other clinical findings were ptosis (1), diplopia (1), tinnitus (7), proptosis (7), and carotid-cavernous fistula (CCF) (7). Treatment was instituted either as a reconstructive procedures (in 10 patients) or parent artery occlusion (PAO) (in 10 patients).

Epistaxis, due to intracranial ICA pathologies is a life-threatening condition that needs urgent treatment. The plethora of causes underlying this aggressive condition can be safely mitigated using the endovascular route, which offers a more straightforward, reliable, and safer treatment compared with the surgical modality.