Fig. 4

Computed tomography of patient after stabilization a axial non-contrast section demonstrates soft tissue with air foci at the suspected site of external carotid artery breech (arrow). b Axial section angiography shows the presence of contrast extravasation (open arrow) and persistence of contrast in delayed image s(not shown here). c Coronal CT angiogram shows the presence of contrast extravasation adjacent to right external carotid artery (arrowhead). Endovascular treatment of ECA blowout. Digital subtraction angiography of the same patient. d Digital subtraction angiogram through multipurpose catheter (MPA catheter, Cook medical llc, USA) inverted image of common carotid artery (CCA) shows focal outpouching of the right ECA at the suspected site which is correlating with CT angiogram just proximal to ligular artery (arrow). e Superselective cannulation of ligular artery using 2.7 Fr Progreat microcatheter (Terumo, Japan) and by anchoring technique (arrow) (long length coil is use to anchor the smaller side branch of the bigger parent artery which help in stabilizing the primary coil in the main artery following which subsequently other coil were placed proximal to that to fill the lumen of the bigger parent artery without migration under the support of the anchor coil) coil embolization (hilal embolization microcoil™,Cook medical llc, USA) of the ECA was done (open arrow). f Post coil embolization angiogram image shows complete occlusion ECA distal to superior thyroid artery (arrow) and completer obliteration of ECA and its branches by coil (arrowhead)