Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

Figure 2

Embolization of the left internal maxillary artery/sphenopalatine artery (IMA/SPA) in a 49-year-old female patient with hereditary hemorrhagic telangiectasia. A.p. (a) and 48° LAO (b, c) Angiogram of left external carotid artery (ECA) shows arterial supply of nasal cavity via IMA. (a, b) Main supply of Kiesselbach’s plexus (asterisk) is provided via SPA, but there also collaterals to the superior labial artery (SLA, a branch of the facial artery FA). (c) Angiogram after embolization with micospheres and coils: there is no contrast flow in the SPA. Particle embolization of the SPA/distal IMA needs to be done very carefully to avoid accidental nontarget embolization of the middle meningeal artery (MMA) with possible hazardous anastomoses to ICA branches. Also shown is the labial artery (LA), temporal artery (TA), buccal artery (BA), occipital artery (OccA), descending palatine artery (DPA), and inferior alveolar artery (IAA).