Endovascular management of an embedded intracranial knife.

BACKGROUND Endovascular therapy (ET) is infrequently used in the setting of acute penetrating intracranial trauma. METHODS We report a case where ET was used immediately prior to and following removal of an embedded intracranial knife, which was found to be disrupting the anterior cerebral artery. RESULTS The proximal vessel was coiled and angiographically occluded and then the knife was removed with the microcatheter in place. Immediate angiography allowed us to see and quickly treat the contrast extravasation with further coiling. Despite full medical management, the patient died of elevated intracranial pressure. CONCLUSION In this severely injured patient, endovascular therapy represented the most suitable means to attempt safe removal of the knife.