Embolization for epistaxis 

Step 1: verify origin of ophthalmic artery is off ICA and not off MMA -- or rather, verify that the eye has good collateral blood supply from ICA and is not entirely dependent off anomalous MMA-based supply. 

There are quiet collaterals between the MMA and the the ophthalmic artery -- if the standard ophthalmic artery fails to develop in utero, or if for some reason is occluded slowly (like pipeline across supraclinoid ICA) you will develop these collaterals (termed meningo-ophthalmic artery). In this example you can see a nice ophthalmic off ICA. 

an example of meningo-ophthalmic artery from neuroangio.org. Note: this is an ECA injection, with the Imax at the lower edge of screen, STA on far R lower corner, MMA in bright red, ophthalmic artery in black -- note that the ICA is filling retrograde via ophthalmic artery from MMA. Pretty cool stuff. Anterior is left. 

THIS IS IMPORTANT because epistaxis embolization involves embolizing the Imax with particles. You push catheter past MMA but particles can still reflux into MMA and if someone's has a meningo-ophthalmic and does not have good collateral from an ophthalmic coming off ICA, you can cause monocular blindness from this procedure. 

step 2: microcatheter into Imax DISTAL to MMA 

then inject particles, coils, or even tiny pledgets of gelfoam.