Coil Embolization of the Internal Carotid Artery in Patient with Retained Transcranial Knife

Abstract

We describe endovascular coil embolization of the internal carotid artery before removing a retained knife blade partially occluding the lacerum segment of the internal carotid artery. A 21-year-old male presented to the emergency department with a retained transcranial knife after sustaining a stab to the left temporal scalp. He was hemodynamically stable and neurologically intact on presentation. Computed tomography angiography followed by digital subtraction angiography revealed narrowing of the lacerum segment of the left internal carotid artery by the tip of the knife blade with adequate blood flow from the contralateral internal carotid artery. Embolization and occlusion of the internal carotid artery proximal and distal to the knife tip were performed. The patient was transferred to the neurosurgical operating room for extraction of the knife. A repeat left carotid artery angiogram post knife extraction showed no displacement of the coils and no extravasation of contrast. Follow-up imaging confirmed a good outcome. A staged approach of digital subtraction angiography and endovascular therapy followed by surgical treatment is a safe and effective management strategy for patients presenting with a retained transcranial knife and suspected vascular injury.