Foreign body embolization of the middle cerebral artery: review of the literature and guidelines for management.

Two cases of traumatic middle cerebral artery occlusion secondary to migratory intravascular metallic pellets are presented. Surgical removal of the occlusive pellet was achieved in one patient, and vessel patency was restored. One patient recovered from his neurological deficit without surgical intervention. Factors such as the availability of a microvascular surgeon, the status of the neurological deficit resulting from the embolus, the time interval from injury to the proposed operation, and the extent of ancillary injuries sustained concurrently all bear weight on the decision to explore surgically or treat by medical measures. We believe that in cases of trauma an attempt to remove intravascular emboli is warranted to prevent migration of the embolus and distal propagation of thrombus, to avoid chronic sepsis, to prevent arterial erosion, and to restore the integrity of the vascular tree.