Abstract 324: Management of Head and Neck Pseudoaneurysms: an Institutional Review

Introduction/Purpose Intracranial pseudoaneurysms (PSA) are a challenging clinical entity. A variety of endovascular techniques including coiling, vessel occlusion, stent‐assisted coiling, and flow diversion are available treatment options. When aneurysm morphology permits, selective coiling is preferred as it avoids the negative sequelae associated with parent vessel deconstruction. Here we review a series of symptomatic PSAs and outcome their endovascular management. Materials and Methods We performed an institutional review of the electronic medical record to identify pseudoaneurysms of the head and neck in order to analyze their disease course and outcome of endovascular therapy. Results We identified 6 separate cases of head and neck pseudoaneurysms treated with endovascular management. Four cases were managed by selective coiling. In two instances selective coiling was definitive. In the others, selective endovascular coiling was initially successful, but later required revision with parent vessel occlusion. In each case requiring revision, progression of the original pathologic process which contributed to the initial pseudoaneurysm led to the failure of selective coiling. The two cases managed with flow diversion did not require revision or have any immediate complications. Conclusion Selective coiling remains a useful endovascular therapy, however in progressive pathologies such as malignant neoplasms there may be a greater likelihood of revision with parent vessel occlusion.