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

Figure 4

Re-embolization of left external carotid artery (ECA) due to an accessory artery from IMA in a 72-year-old male patient with epistaxis (risk factor: anticoagulation). (a) Angiogram of ECA shows coils in the internal maxillary artery (IMA) and sphenopalatine artery (SPA, open white arrow) after embolization 53 days earlier. However, there is an accessory artery rising from of the proximal IMA (black arrow), then running to the dorsal part of the nasal cavity, potentially being responsible for the rebleeding. (b) Decision was made to embolize the ECA to stop the blood supply to this artery. No particles were used. Embolization was performed with coils (white arrow). Also shown are middle meningeal artery (MMA) and temporal artery (TA).