Shotgun pellet embolization to the intracranial internal carotid artery: Report of a case and review of the literature

Shotgun wound and pellet embolism to the intracranial carotid artery

“…These embolic missiles are of low velocity, and they don't have enough kinetic energy to pass completely through tissues. 4 Although many times the site of penetration into the arterial system was not clearly identified, in the cases of neck injury 2-4,6-11 the carotid artery was usually the point of penetration, although one case of vertebral artery was described. 4 When the chest has been involved, 1,2,4,5,[11][12][13] the metallic foreign body is dislodged into the intracranial circulation through the aorta, supra-aortic vessels, left ventricle, or even the pulmonary veins.…”

“…1,5,6 In two facilities, the injury was discovered at necropsy. 4,12 In cases of children with an injury from an air gun, the physician needs to have a heightened awareness that innocuous appearing entry wounds could be deep, penetrating, and lethal. 2 In this type of lesion, at the time of the lesion, plain X-rays are essential to localize the pellets.…”

“…In the majority of cases, they were lodged into the middle cerebral artery (73.8%), 1,2,4-6,8-12 but in eight cases they were in some portion of the internal carotid artery because the vessel restricted the migration (ie, air gunshot). 2,4,13 Generally, the missile embolism takes place with some delay (hours, days, or even months) after admission into the hospital. 4 This delayed cerebral embolization was sometimes due to maneuvers of cardiac resuscitation, attempts of withdrawal, or migration due to progressive arterial wall erosion from the pulmonary veins or ventricles.…”

“…2,4,13 Generally, the missile embolism takes place with some delay (hours, days, or even months) after admission into the hospital. 4 This delayed cerebral embolization was sometimes due to maneuvers of cardiac resuscitation, attempts of withdrawal, or migration due to progressive arterial wall erosion from the pulmonary veins or ventricles. 1,5,6 In two facilities, the injury was discovered at necropsy.…”

“…This fact explains that the right side of the brain was more frequently damaged. [1][2][3][4]12,13 On the other hand, the small size and shape of the missile are factors that contribute to its retention into a particular location. In the majority of cases, they were lodged into the middle cerebral artery (73.8%), 1,2,4-6,8-12 but in eight cases they were in some portion of the internal carotid artery because the vessel restricted the migration (ie, air gunshot).…”