Endovascular treatment for radiation-induced internal carotid artery pseudoaneurysm and usefulness of angiographic and nasal endoscopic confirmation

Radiation induced carotid vasculopathy may present as steno-occlusive disease or less commonly as a pseudoaneurysm. Rupture of internal carotid artery (ICA) pseudoaneurysm can be a fatal complication in patients with nasopharyngeal carcinoma (NPC). Location of the pseudoaneurysm at the skull base makes surgical treatment very difficult. Endovascular therapy may be the treatment of choice. Preserving patency of the carotid artery is a desirable option, but incomplete occlusion of bleeding point of pseudoaneurysm may cause re bleeding. Both angiographic and nasal endoscopy confirmation of occlusion may help to avoid re-bleeding. We describe a case of endovascular treatment for massive epistaxis due to rupture of radiation-induced ICA pseudoaneurysm in a patient with NPC, and would like to discuss significance of angiographic and nasal endoscopic confirmation.