Emergency endovascular treatment of petrous carotid artery false aneurysm

Abstract

Introduction:The management of ruptured intracranial false aneurysms (IFAs) might be tricky as any kind of treatment modality, surgical or endovascular, is burdened with significant challenges. A case report of the endovascular treatment of IFA in emergency setting is presented to provide more understanding of its pathophysiology as well as of the best operative work-up for petrous carotid artery reconstruction. Methods: Technical notes from a left sided skull base abscess, involving and eroding the carotid canal and petrous carotid artery (PCA) resulting in an IFA are shown and analyzed. Results: Balloon-assisted low viscosity Onyx embolization seems an effective method for the emergency treatment of IFA. Indications, technical nuances, and peri-and post-procedural complications are thoroughly discussed. A flow chart for the management of IFA is also proposed. Conclusions: The combination of parent artery balloon protection and low viscosity Onyx embolization can provide an effective occlusion of the IFA while maintaining parent artery patency. Normal distal filling of the parent artery, and optimal obliteration of the IFA are easily achievable.

Mycotic Pseudoaneurysm Associated with Skull Base Osteomyelitis Treated with Endovascular Embolization

“…In two previous cases, the proximal MMA was embolized using n-butyl cyanoacrylate, a synthetic glue [ 6 - 7 ]. Balloon-assisted low viscosity Onyx embolization has been reported to be an effective method for emergency treatment of infected pseudoaneurysms while maintaining parent artery patency [ 8 ]. In our case, the coil was placed at a distance from the site of the mycotic pseudoaneurysm at the origin of the MMA in order to avoid an additional nidus for infectious complications.…”