![]() Įndovascular treatment can be based on either closing the injured vessel or repairing the vascular wall tear. In particular, in the case of cavernous ICA acute injury, the control of bleeding can be obtained using an endovascular procedure, endonasal endoscopic approach, or combined techniques. Among the carotid segments of the most difficult management in the case of acute rupture is the cavernous tract. ![]() Among the causes of ICA acute injury are traumatic damage, iatrogenic procedure, and neoplastic invasion. The internal carotid artery (ICA) acute bleeding is one of the most serious neurovascular emergencies that require rapid diagnostic framing and therapeutic targeting. ![]() A combined endoscopic endonasal technique to support the extracranial side of the vessel using autologous flaps or grafts can be performed to prevent the risk of rebleeding. ConclusionsĪlthough the treatment of choice for cavernous ICA acute bleeding remains the occlusion of the injured vessel, in cases of poor hemodynamic compensation at the BTO, the endovascular FDS emergency placement can be effective. In these two cases, we proceeded with an endoscopic endonasal procedure to resurface the exposed ICA wall in the sphenoid sinus. No further bleeding occurred in 3 patients, while 2 cases experienced a mild rebleeding in a period ranging from 5 to 15 days after the endovascular procedure. All patients had a regular clinical evolution, without general complications or new onset of focal neurological deficits. No patient had periprocedural ischemic-hemorrhagic complications. In two patients, an innovative “sandwich technique” combining the endovascular reconstruction with an extracranial intrasphenoidal cavernous ICA resurfacing with autologous flaps or grafts by endoscopic endonasal approach was performed. An FDS was placed with parallel intravenous infusion of abciximab in 3 cases and tirofiban in 2 cases. A concomitant balloon occlusion test (BOT) was performed, to exclude post-occlusive ischemic neurological damage. After an immediate nasal packing to temporarily bleeding control, patients underwent digital subtraction angiography (DSA) to identify the site of the ICA injury. We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e., 3 iatrogenic, 1 post-traumatic, and 1 erosive neoplastic. To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach.
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