• Zaid Aljuboori, Kimberly Meyer, Dale Ding, and Robert James.
• Department of Neurological surgery, University of Louisville, Louisville, Kentucky, USA. Electronic address: zaid.aljuboori@yahoo.com.
• World Neurosurg. 2020 Jan 1; 133: 201-204.

ObjectiveTraumatic pseudoaneurysms of the proximal middle cerebral artery (MCA) segments are challenging to treat. We describe the management of traumatic internal carotid artery and MCA pseudoaneurysms with flow diversion.Case DescriptionA 19-year-old man had sustained a gunshot wound to the head. Delayed digital subtraction angiography showed de novo formation of the left internal carotid artery ophthalmic segment and left MCA M2 segment pseudoaneurysms. We had initially performed coil embolization of the left MCA pseudoaneurysm. However, it had recurred 2 weeks later. We treated both pseudoaneurysms with flow diversion using the Pipeline Flex embolization device. The patient has continued with dual antiplatelet therapy of aspirin and ticagrelor. Follow-up digital subtraction angiography at 6 months showed complete obliteration of both pseudoaneurysms with patent parent vessels. The patient remained neurologically intact.ConclusionsFlow diversion can be an efficacious treatment of traumatic MCA pseudoaneurysms in appropriately selected cases. The risks versus benefits of dual antiplatelet therapy must be weighed in trauma settings.Copyright © 2019 Elsevier Inc. All rights reserved.

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