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  • Endovascular intervention for the treatment of epistaxis: cone beam CT review of anatomy, collateral, and treatment implications/efficacy

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Neuroimaging
Review
Endovascular intervention for the treatment of epistaxis: cone beam CT review of anatomy, collateral, and treatment implications/efficacy
  1. Madeline Hoover1,
  2. Robert Berwanger1,
  3. John A Scott2,3,
  4. Andrew DeNardo2,3,
  5. Krishna Amuluru2,3,
  6. Troy Payner2,
  7. Charles Kulwin2,
  8. Eytan Raz4,
  9. Daniel Gibson5,
  10. Daniel H Sahlein2,3
  1. 1 Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
  2. 2 Goodman Campbell Brain and Spine, Carmel, Indiana, USA
  3. 3 Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA
  4. 4 Radiology, NYU Grossman School of Medicine, New York, New York, USA
  5. 5 Neurointerventional Surgery, Ascension Columbia St. Mary's Hospital, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr Daniel H Sahlein, Neuroendovascular, Goodman Campbell Brain and Spine, Carmel, Indiana, USA; dsahlein{at}goodmancampbell.com

Abstract

Epistaxis is common, impacting more than half the population, and can require procedural intervention in approximately 10% of cases. With an aging population and increasing use of antiplatelets and anticoagulants, severe epistaxis is likely to increase in frequency significantly over the next two decades. Sphenopalatine artery embolization is rapidly becoming the most common type of procedural intervention. The efficacy of endovascular embolization is dependent on a refined understanding of the anatomy and collateral physiology of this circulation as well as the impact of temporizing measures such as nasal packing and inflation of a nasal balloon. Likewise, safety is dependent on a detailed appreciation of collateralization with the internal carotid artery and ophthalmic artery. Cone beam CT imaging has the resolution to enable a clear visualization of the anatomy and collateral circulation associated with the arterial supply to the nasal cavity, in addition to assisting with hemorrhage localization. We present a review of epistaxis treatment, a detailed description of anatomic and physiologic considerations informed by cone beam CT imaging, and a proposed protocol for sphenopalatine embolization for which there is currently no standard.

  • blood flow
  • intervention
  • technique

https://doi.org/10.1136/jnis-2022-019966

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    Footnotes

    • Twitter @eytanraz

    • Contributors DHS: primary author, conceptual design, data/figure oversight and interpretation, guarantor, drafting, revision and final approval of manuscript. MH: assisted with conceptual design, data/figure oversight and interpretation, major contributions to manuscript, final approval of manuscript. RB: assisted with conceptual design, data/figure oversight and interpretation, major contributions to manuscript, final approval of manuscript. JAS: concept approval, data/figure interpretation, revision and final approval of manuscript. AD: concept approval, data/figure interpretation, revision and final approval of manuscript. KA: concept approval, data/figure interpretation, revision and final approval of manuscript. TP: concept approval, data/figure interpretation, final approval of manuscript. CK: concept approval, data interpretation, revision and final approval of manuscript. ER: concept approval, major contributions to manuscript, data/figure interpretation, drafting, revising and final approval of manuscript. DG: concept approval, major contributions to manuscript, data/figure interpretation, drafting, revising and final approval of manuscript. All authors are accountable for all aspects of the work as it relates to questions related to its accuracy and integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DHS: grant from Microvention, consulting fees from Medtronic, Microvention and Phonex, support for attending meetings from Medtronic and Microvention, payment or honoraria for lectures from Medtronic and Microvention, equity from Scientia and Vasorum. AD: payment or honoraria from Cerenovus, payment for expert testimony. KA: consulting fees from Medtronic. TP: royalties from Stryker, payment for expert testimony. ER: consulting fees from Balt, Imperative Care and Medtronic, payment or honoraria for lectures from Penumbra, Medtronic, Stryker, Rapid Medical, Micrvention and Phenox, stock with Siemens, equity from Siemens, proctor for Microvention, site PI for PROST, Inspire and NECC. DG: consulting fees from iSchemaView, participation in RAPID AI Advisory Board, Chair of Stroke Performance Measures Oversight Committee (Stroke Council/American Heart Association).

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