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Case report
Endovascular retrieval of bullet fragment from the basilar artery terminus
  1. Syed Uzair Ahmed,
  2. Michael E Kelly,
  3. Lissa Peeling
  1. Division of Neurosurgery, Department of Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
  1. Correspondence to Dr Lissa Peeling, Division of Neurosurgery, Department of Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan S7N 0W8, Canada; lissa.peeling{at}


A pediatric patient presented after a gunshot injury to the right shoulder and thorax region, with injuries requiring a thoracotomy, tracheal repair, axillary artery repair, and external fixation of the humerus. A CT scan of the brain showed a metal fragment in the interpeduncular cistern. CT angiography confirmed a pellet occluding the basilar apex. Successful endovascular retrieval resulted in mobilizing the pellet from the basilar apex to the left vertebral artery proximal to the posterior inferior cerebellar artery. This vertebral artery was then sacrificed proximally to prevent re-embolization. We present our technique and discuss endovascular options for management of intracranial arterial embolization of bullet fragments.

  • Stroke
  • Embolic
  • Thrombectomy
  • Stent
  • Technique

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  • Contributors LP and MK performed the intervention. SUA and LP drafted the manuscript and figures. SUA, LP and MK edited the manuscript.

  • 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 SUA reports no competing interests. LP reports no competing interests. MK reports competing interests in the form of consulting fees from Imperative Care and research grant funding from the Saskatchewan Heath Research Foundation. In addition, he is a board member of the Heart and Stroke Foundation of Saskatchewan.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.