Endovascular treatment of radiation-induced petrous internal carotid artery aneurysm presenting with acute haemorrhage. A report of two cases

Haemorrhage from rupture of petrous ICA aneurysm can be life threatening an d emergency treatment is required. We report 2 cases of radiation-induced p etrous internal carotid artery (ICA) aneurysm presenting with acute haemorr hage (epistaxis and otorrhagia) after radiotherapy (RT) for nasopharyngeal carcinoma (NPC). Both patients had a history of RT treatment for NPC. The f irst patient, a 54-year-old man, presented with sudden severe epistaxis and haemorrhagic shock. The second patient, a 35-year-old man, presented with episodes of severe otorrhagia. The first patient was immediately resuscitat ed. Obliteration of the aneurysm was performed by endovascular occlusion of the ICA with Guglielmi detachable coils and fibered platinum coils. For th e second patient, the aneurysm was treated by deploying a self-expandable s tent across the aneurysm neck. In an emergency situation, ruptured petrous ICA aneurysm can be treated with endovascular occlusion of the ICA with mic ro-coils if there is a good collateral blood flow. Alternatively, the aneur ysm can be treated by deployment of a stent, which can induce stasis and ev entual thrombosis of the aneurysm.