Massive Epistaxis Related to Petrous Carotid Artery Pseudoaneurysm After Radiation Therapy: Emergency Treatment with Covered Stent in Two Cases

Summary: Two patients had acute left carotid rupture from radiation therapy–induced pseudoaneurysms, resulting in hemodynamic collapse. Because the patients were semico-matose and in shock, an immediate salvage procedure was needed. Location of the pseudoaneurysm at the skull base made surgical treatment less possible. Endovascular ther-apy was the treatment of choice. Preserving patency of the carotid artery was a desirable option. The successful use of a covered stent in the emergency treatment of massive epistaxis due to active bleeding from pseudoaneurysm in the petrous internal carotid artery (ICA) is described. Saccular aneurysms of the petrous carotid artery are rare. Most of the aneurysms are pseudoaneurysms that are related to congenital, traumatic, mycotic, and inflammatory causes. Because of the location within the petrous bone, a direct surgical approach is diffi-cult, if not impossible