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Endovascular occlusion of a persistent stapedial artery prior to stapedotomy: a novel approach

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Abstract

Background

The stapedial artery is an embryonic artery that transiently supplies the cranial vasculature of the human embryo. Postnatal persistence of the stapedial artery may cause conductive hearing loss and pulsatile tinnitus due to its course through the middle ear. We describe a patient with a persistent stapedial artery (PSA) managed by endovascular coil occlusion prior to stapedotomy.

Methods

A 48-year-old woman presented with left-sided conductive hearing loss and pulsatile tinnitus. Ten years earlier the patient had undergone explorative tympanoplasty, which was aborted due to a large PSA. Digital subtraction angiography was performed to confirm the anatomy and endovascular occlusion of the proximal PSA was achieved by deployment of coils.

Results

The pulsatile tinnitus improved immediately after the procedure. The size of the artery subsequently decreased and surgery could be performed with only a minor intraoperative bleeding. Successful stapedotomy resulted in postoperative normalization of her hearing with some minor residual tinnitus.

Conclusion

Endovascular coil occlusion of a PSA is feasible and safe in patients with favorable anatomy and facilitates middle ear surgery. It decreases the size of the artery and minimizes the risk of intraoperative bleeding in patients with a large PSA. The future role of this novel technique in the management of patients with PSA-related conductive hearing loss and pulsatile tinnitus remains to be determined.

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Data availability

Not applicable.

Abbreviations

EVO:

Endovascular occlusion

CHL:

Conductive hearing loss

ICA:

Internal carotid artery

MMA:

Middle meningeal artery

PSA:

Persistent stapedial artery

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Acknowledgements

We would like to thank Dr. Susan Diethelm Jacobsen (Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark) for providing the early clinical history of the patient and for supporting our approach.

Funding

None.

Author information

Author notes

  1. Sune Land Bloch, Rasmus Holmboe Dahl have contributed equally to this work.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Sune Land Bloch

  2. Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Rasmus Holmboe Dahl & Goetz Benndorf

  3. Department of Radiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark

    Rasmus Holmboe Dahl

  4. Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark

    Klaus Hansen

  5. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Goetz Benndorf

Authors
  1. Sune Land Bloch
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  2. Rasmus Holmboe Dahl
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  3. Klaus Hansen
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  4. Goetz Benndorf
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Correspondence to Goetz Benndorf.

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Bloch, S.L., Dahl, R.H., Hansen, K. et al. Endovascular occlusion of a persistent stapedial artery prior to stapedotomy: a novel approach. Eur Arch Otorhinolaryngol 280, 4701–4707 (2023). https://doi.org/10.1007/s00405-023-08092-9

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  • DOI: https://doi.org/10.1007/s00405-023-08092-9

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