Introduction The stapedial artery is an embryonic artery that transiently supplies the cranial vasculature of the human embryo. Postnatal persistence of the stapedial artery may cause conductive hearing loss and pulsatile tinnitus due to its course through the middle ear. The artery may be identified coincidentally on brain CT scans where the foramen spinosum is often absent and may be associated with other vascular variants. In clinical practice, a persistent stapedial artery (PSA) can be found in conjunction with stapes surgery for otosclerosis. We present a patient with a PSA who underwent cerebral angiography and endovascular coiling of the PSA prior to stapedotomy. To our knowledge, endovascular occlusion of a PSA has never been reported although it has been mentioned by several authors as a possible alternative option to surgical techniques.

Materials and Methods A 48-year-old woman presented with left-sided conductive hearing loss and pulsatile tinnitus. The patient had previously undergone explorative tympanoplasty, which was aborted due to the PSA. Digital subtraction angiography showed a PSA arising from the cervical portion of the internal carotid artery, which coursed through the middle ear and supplied the MMA territory (figure 1A). Three small detachable coils (Target^® 360 & helical (1 mm), Stryker, Kalamazoo, MI, USA) were deployed in the caroticotympanic artery 5 mm below the stapes. The position of the coils in the caroticotympanic canaliculus was confirmed by cone-beam CT (figure 1B).

Results The pulsatile tinnitus improved immediately after the procedure. A reduced size of the artery was subsequently found during middle ear surgery that could be performed with only a minor perioperative bleeding. Successful stapedotomy resulted in postoperative normalization of her hearing with some minor residual tinnitus. The patient reported a non-continuous minimal residual tinnitus not affecting her much.

Conclusion A PSA is a rare vascular variant and can be associated with other anomalies involving the arterial and osseous structures of the middle ear. Endovascular occlusion of a PSA is a feasible and safe procedure in patients with favorable vascular anatomy. It can decrease the size of the PSA prior to middle ear surgery and thereby minimizing the risk of peroperative bleeding and allowing for stapedotomy especially in patients with a large PSA. The exact role of endovascular occlusion for the treatment of PSA-related conductive hearing loss and pulsatile tinnitus remains to be determined.

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Abstract E-122 Figure 1

Disclosures R. Holmboe Dahl: None. S. Bloch: None. K. Hansen: None. G. Benndorf: None.