A boxer with a pipeline stent in the brain- Should this boxer be allowed to participate in professional boxing fight?

Abstract

Professional boxing is a popular combat sport which unfortunately carries a high risk of acute traumatic brain injury (TBI). The nature of the sport is such that every punch thrown to the opponent’s head is thrown with the intention of winning by causing a concussive head injury (aka a knockout). Professional boxing is regulated by various State Athletic Commissions in the United States and abroad. Most commissions require an imaging study of the brain (either a computed tomography scan or a magnetic resonance scan) prior to licensure. The primary goal of neuroimaging prior to licensure is to identify and/or exclude coincidental or clinically suspected brain lesions which may pose a risk for rupture, bleeding, or other catastrophic brain injury during a bout/training. These lesions include aneurysms, arteriovenous malformations, cavernous malformations, large venous malformations, Vein of Galan malformations among others. A boxer with history of a left ophthalmic artery aneurysm status post embolization with placement of a pipeline shield in the distal left internal carotid artery (ICA) presented for licensure. Should this boxer be allowed to participate in professional boxing is debated.