Surgical Iatrogenic Internal Carotid Artery Injury Treated with Pipeline Embolization Device: Case Report and Review of the Literature

Abstract

Objective: Case reports in regard of using Pipeline Embolization Devices (PED): endoluminal reconstruction device for treatment of iatrogenic internal carotid artery (ICA) injury is still rare. We describe a successfully treated case of surgical iatrogenic ICA injury by double overlapped PEDs placement.Case Presentation: A 79-year-old female underwent endoscopic trans-nasal aspiration for chronic sphenoid and ethmoid sinusitis. This surgery was complicated by brisk arterial bleeding developed along the right lateral wall in the sphenoid sinus. There was a concern that the bleed could related to a tear in the cavernous segment of the right ICA.Immediate angiogram showed a small pseudo-aneurysm appearance, corresponding with the injured site. The pseudoaneurysm spontaneously disappeared, however, owing to recurrence of arterial nasal bleeding of upon nasal packing removal, double overlapped PEDs were successfully placed in the right ICA cavernous/supraclinoid segment. Immediate cessation of bleeding was achieved and packing could be removed. Conclusion:The use of PED for surgical iatrogenic ICA injury appears to be a rational therapeutic alternative with preservation of the parent artery blood flow.Keywords▶ surgical iatrogenic internal carotid artery injury, pseudo-aneurysm, parent artery preservation, flow diverter, neurosurgery