Article Text

Download PDFPDF
Case report
Republished: Intracranial pellet embolization: an endovascular endeavor
  1. Ameer E Hassan1,2,
  2. Rani Ramsey Rabah1,
  3. Wondwossen Tekle1,2
  1. 1 Clinical Research Department, Valley Baptist Medical Center - Harlingen, Harlingen, Texas, USA
  2. 2 Department of Neurology, UTRGV School of Medicine, Edinburg, Texas, USA
  1. Correspondence to Dr Ameer E Hassan; ameerehassan{at}


A 44-year-old man was referred to the neurointerventionalist 6 hours after sustaining a shotgun wound to the left chest, shoulder, and neck from 4 feet away. Physical examination of the chest showed a 5 cm × 5 cm gunshot entry wound on the anterior-superior aspect of the chest involving the supraclavicular and infraclavicular region, with multiple gunshot pellet entry sites riddled in the surrounding vicinity. The patient was taken for a CT scan of the brain without contrast and CT angiography, which showed no sign of stroke or intracranial hemorrhage but revealed a single 'buckshot' pellet embolizing the basilar artery tip, occluding the origin of the left posterior cerebral artery. Using A Direct Aspiration First Pass Technique (ADAPT), the neurointerventinalist was able to endovascularly remove the embolized pellet and the patient was discharged 8 days later with no focal neurological deficit.

  • embolic
  • catheter
  • CT angiography
  • thrombectomy
  • technique

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Republishing Republished with permission from BMJ Case Reports. Published 31 December 2019; doi:10.1136/bcr-2019-015301

  • Contributors All three authors of this case report contributed to its completion. One neurointerventionalist performed the procedure, and the remaining two authors helped write and edit the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.