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Internal carotid artery ICA injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. A retrospective review of transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated.

Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. Seven cases were identified from the institutional cohort mean age Five injuries occurred at our institution 5 [0.

Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization coil or stent-assisted coil placement , and 2 underwent endoluminal reconstruction both with flow diversion devices.

Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction.