Traumatic intra-extracranial arterial injuries still represent common events of both closed head injury and penetrating head trauma. These injuries include arterial dissection, pseudoaneurysms and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia or life-threatening epistaxis. Endovascular therapy has played a major role in the management of these lesions but only with senior full trained neurointerventionists and on the principles of a neurologic critical care team to minimize secondary brain injuries.
