PMC10247217_01
Contrast CT showing (A) right zygomatic arch defect, (B) atrophy of the right masticatory muscle, (C) arterial phase, and (D) venous phase. Extravascular leakage (arrowhead) from the right STA is noted. CT, computed tomography; STA, superficial temporal artery
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Head computed tomography (CT) revealed a right zygomatic arch defect (Fig. 1A), atrophy of the masticatory muscles (Fig. 1B), and extravasation from the STA within the subcutaneous hematoma (Fig. 1C, D); consequently, endovascular treatment was chosen.
Cerebral angiography was performed on the (A) frontal, (B) lateral, and extravascular leakage in the right STA parietal branch. (C) Coil embolization distal to the bleeding site, (D) NBCA administration, and (E) coil embolization of the proximal side were observed on angiography. NBCA, n-butyl-2-cyanoacrylate; STA, superficial temporal artery
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A pseudoaneurysm was observed in the parietal branch of the right STA (Fig. 2A, B). A microcatheter was distally guided to the rupture site, and the distal segment was embolized with two coils (Fig. 2C). Subsequently, the segment including the aneurysm was obliterated with n-butyl-2-cyanoacrylate (NBCA) (Fig. 2D). At the end of the procedure, we embolized the proximal segment of the artery with coils due to the potential arterial stretch injury related to the massive hematoma (Fig. 2E).
A new extravascular leakage anterior to the site of the previous hemorrhage is shown by (A) arterial and (B) venous phase contrast CT. Cerebral angiography of the (C) frontal and (D) lateral views are also shown, revealing the new extravascular leakage at the right STA frontal branch. (E) Coil embolization distal to the bleeding branch of the frontal branch and (F) NBCA embolization proximal to the bleed were performed. CT, computed tomography; NBCA, n-butyl-2-cyanoacrylate; STA, superficial temporal artery
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However, we observed an enlarged subcutaneous hematoma on postoperative day 1 and confirmed a new extravascular leak by CT (Fig. 3A, B). Furthermore, the frontal branch of the STA was confirmed to be bleeding, which was not observed in the digital subtraction angiography performed the previous day (Fig. 3C, D). Accordingly, the frontal branch distal to the bleeding site was coil embolized (Fig. 3E), and subsequently, the NBCA was proximally injected, which successfully reached the affected branch and blocked blood flow to the bleeding location (Fig. 3F).