A Recurred Carotid Siphon Pseudoaneurysm after Detachable Coil Embolization

Massive posterior epistaxis is one of the peculiar symptoms of pseudoaneurysms of the carotid siphon. We experienced a case of trauma-related pseudoaneurysm of the carotid siphon. The lesion was initially silent except for the mass effect. We initially treated the lesion with platinum detachable coil embolization of the pseudoaneurysm sac with preservation of the parent artery. However, the patient had delayed massive epistaxis with recurrence of the pseudoaneurysm. The patient was subsequently managed with endovascular occlusion of the affected internal carotid artery using detachable balloons. Complete internal carotid artery trapping is recommended as an initial treatment modality if the patient can tolerate to the occlusion test. Careful observation and follow-up of the patient is required if the lesion is inevitably managed with coil embolization of the pseudoaneurysm sac alone.