From the Guidelines
Coils can be used for endovascular embolization of epistaxis, particularly for severe or recurrent cases that do not respond to conventional treatments. This approach is supported by recent clinical practice guidelines, such as the one published in 2020 by Tunkel et al 1, which highlights the importance of intensive management for patients with refractory nosebleeds. Endovascular embolization procedures, including coil embolization, have been shown to be effective in achieving acute control of nasal bleeding, with a success rate of over 90% 1.
The procedure typically involves targeting branches of the external carotid artery, such as the sphenopalatine artery, internal maxillary artery, or facial artery, which are commonly involved in epistaxis, as illustrated in Figure 1 of the guideline 1. Coil embolization works by promoting thrombosis and occluding blood flow to the bleeding vessel, and is often used in combination with other embolic agents for more complete devascularization.
Some key considerations for coil embolization in epistaxis include:
- The use of detachable coils of appropriate size (typically 2-4mm diameter) to ensure effective occlusion of the bleeding vessel
- The importance of precise targeting and deployment of coils under fluoroscopic guidance to minimize the risk of complications
- The potential for complications, such as inadvertent embolization of non-target vessels, tissue necrosis, and neurological complications, which can be mitigated by performing the procedure in an experienced center with skilled interventional radiologists or neurointerventionalists.
Overall, coil embolization is a valuable option for the management of severe or recurrent epistaxis, and should be considered as part of a comprehensive treatment approach that prioritizes morbidity, mortality, and quality of life outcomes.
From the Research
Endovascular Embolization for Epistaxis
- Coils can be used for endovascular embolization of epistaxis, as demonstrated in a study published in 2015 2, which used supersoft platinum microcoils as the sole embolic agent in 12 consecutive cases.
- The study found that superselective microcoil embolization was effective in treating severe intractable epistaxis, with short-term success in 75% of patients and long-term success in 50% of patients 2.
- Another study published in 2011 3 reported a success rate of 93.5% for embolization in patients with idiopathic epistaxis, and 91.7% for patients with traumatic or iatrogenic epistaxis.
- The use of coils for embolization is also supported by a study published in 2013 4, which noted that embolization has been used to treat epistaxis for over 30 years, with success rates of approximately 90% and major complications occurring in approximately 2%.
- A more recent study published in 2025 5 compared endovascular arterial embolization (EAE) with conservative management using nasal packing alone for severe epistaxis, and found that EAE was associated with a significant reduction in epistaxis recurrence rates and lower rates of patient morbidity.
Types of Coils Used
- Supersoft platinum microcoils with smallest diameters were used in the 2015 study 2 to achieve ideal superselectivity of the target vessels.
- The choice of coil type and size may depend on the specific anatomy and etiology of the epistaxis, as well as the operator's preference and experience.
Complications and Risks
- The studies reported various complications and risks associated with coil embolization, including mucosal damage, nasal pain, and neurological or visual impairment 2, 3, 6.
- A study published in 2002 6 highlighted the importance of follow-up radiologic studies and endoscopic evaluations to avoid delays in diagnosis, as nasal packing and embolization can obscure the underlying source of epistaxis.
- The 2025 study 5 found that EAE was associated with a small but significant increase in risk of ischemic stroke, highlighting the need for careful patient selection and monitoring.