Epistaxis is a frequently managed condition by Ears, Nose and Throat (ENT) surgeons in emergency and outpatient departments. Commonly related to vessels of Little’s area or Woodruff’s plexus, most are addressed under local anaesthetic with intranasal tamponade packing or with in-office cautery. Occasionally, patients are taken to theatre for cautery or ligation of major arterial vessels where blood loss is significant and epistaxis is difficult to control. Since the advent of endovascular interventions in the 1970s, this innovation has become another tool in the ENT’s arsenal, finding use in controlling epistaxis refractory to surgery. We present a case of a 37 year old male admitted having had a 2 day history of high volume bilateral epistaxis and significant anaemia (Haemoglobin [Hb] of 59mg/dl) following intravenous methamphetamine use. Computed tomography (CT) scans on admission as well as serial flexible nasoendoscopy were unable to determine a culprit vessel. Whilst admitted, the patient sustained a catastrophic epistaxis afterhours that required emergency intubation and retrieval to a quaternary centre with interventional imaging capacity. A CT Angiogram in the interventional suite identified an occult carotid artery pseudoaneurysm within the sphenoid sinus and arrested the bleed with endovascular coil embolization – sparing the patient a carotid artery ligation and resulting in an excellent recovery. This case highlights a catastrophic cause of epistaxis related to carotid artery pseudoaneurysm that is rarely seen in the literature and highlights the use of advanced endovascular interventions in the modern age as another modality of epistaxis control.