Article Text

other Versions

PDF
Case report
Pipeline embolization device and subsequent vessel sacrifice for treatment of a bleeding carotid pseudoaneurysm at the skull base: a case report
  1. Yasha Kadkhodayan1,
  2. Vilaas S Shetty1,
  3. Spiros L Blackburn1,
  4. Matthew R Reynolds2,
  5. DeWitte T Cross III1,2,
  6. Christopher J Moran1,2
  1. 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to Dr Yasha Kadkhodayan, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110, USA; yasha.kadkhodayan{at}gmail.com

An attempt at parent vessel reconstruction with Pipeline embolization devices to treat a mycotic pseudoaneurysm of the internal carotid artery at the skull base is presented. A 50-year-old woman with malignant otitis externa and bilateral temporal bone osteomyelitis presented with brisk bleeding from her left ear. She had bony dehiscence of the left carotid canal at CT and extravasation from a pseudoaneurysm of the carotid petrous segment at angiography. Carotid tortuosity proximally precluded placing a covered stent. After the lesion stopped bleeding spontaneously and given the presence of bilateral osteomyelitis putting the contralateral carotid at risk, the decision was made to attempt preservation of the parent vessel with flow diversion. However, bleeding recurred after 12 days, necessitating carotid sacrifice. This first reported experience in treating a carotid pseudoaneurysm at the skull base with the Pipeline device shows that transient cessation of bleeding is insufficient for flow diversion to be effective.

Statistics from Altmetric.com

Footnotes

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CJM is a consultant for ev3/Covidien, Stryker and Codman.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.