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Agarkov M, Kozlov K, Senkina E, Gornov S, Linkova N, Kechaeva E, Medvedev D, Krasichkov A, Dyatlova A, Polyakova V. Endovascular Recanalization and Carotid Stenting: The New Approach to Restore Cerebral Perfusion during Aortic Dissection. J Clin Med 2024; 13:2716. [PMID: 38731245 PMCID: PMC11084725 DOI: 10.3390/jcm13092716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
A type A aortic dissection (TAAD) is a dangerous condition requiring emergency surgery. Due to the similarity of the symptoms of cerebral malperfusion in TAAD and the signs of ischemic stroke, a differential diagnosis of these diseases is not always available. Patients with TAAD after cerebral malperfusion can have a neurological deficit. Thrombolysis is performed in this case. It can worsen the patient's condition and increase the risk of mortality and disability. The aim of the study is to evaluate the new approach to restoring cerebral perfusion during aortic dissection. This approach includes endovascular recanalization and carotid stenting. METHODS Two clinical cases of TAAD complicated by cerebral malperfusion are described. The first patient is 73 years old and was admitted as planned to perform transcatheter aortic valve implantation (TAVI) for grade III aortic stenosis. The patient underwent transcatheter aortic valve implantation (TAVI) on the second day after admission. The second patient is 60 years old and was hospitalized by an ambulance with strong hypertension and ischemia. The surgical correction of aortic dissection was postponed until the neurological status assessment in both patients. RESULTS The surgery to correct the aorta dissection was deemed inappropriate. The carotid arteries have been reanalyzed, and cerebral perfusion has been restored in a short time in both patients. CONCLUSION Acute bilateral internal carotid occlusion is a potentially fatal TAAD outcome. Emergency endovascular recanalization and carotid stenting may be considered one of the few ways to restore cerebral perfusion.
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Affiliation(s)
- Maxim Agarkov
- Interventional Radiology Gusev Central District Hospital, 56, Moskovskaya Str., Gusev, 238051 Kaliningrad Oblast, Russia
| | - Kirill Kozlov
- Military Medical Academy of Ministry of Defense of the Russian Federation, 6, Akademica Lebedeva Str., 194044 St. Petersburg, Russia
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
| | - Ekaterina Senkina
- Alexander’s Hospital, 4, Solidarnosti Ave., 193312 St. Petersburg, Russia
| | - Sergey Gornov
- The Federal Medical-Biological Agency of Russia, 30, Volocolamskoye Highway, 123182 Moscow, Russia
| | - Natalia Linkova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Elena Kechaeva
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Dmitrii Medvedev
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
| | - Alexander Krasichkov
- Department of Radio Engineering Systems of Electrotechnical University LETI, 5F Prof. Popova Str., 197022 St. Petersburg, Russia
| | - Anastasiia Dyatlova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Victoria Polyakova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
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Saad H, Eshraghi S, Alawieh AM, Akbik F, Cawley CM, Howard BM, Ash M, Hsu A, Pabaney A, Maier I, Al Kasab S, El Naamani K, Jabbour P, Kim JT, Wolfe SQ, Rai A, Starke RM, Psychogios MN, Shaban A, Arthur AS, Yoshimura S, Fragata I, Cuellar-Saenz HH, Polifka AJ, Mascitelli J, Osbun JW, Matouk C, Park MS, Levitt MR, Dumont TM, Williamson R, Spiotta AM, Grossberg JA. Technical and clinical outcomes in concurrent multivessel occlusions treated with mechanical thrombectomy: insights from the STAR collaboration. J Neurointerv Surg 2023; 15:1072-1077. [PMID: 36597932 DOI: 10.1136/jnis-2022-019608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) has become the mainstay treatment for large vessel occlusion, with favorable safety and efficacy profile. However, the safety and efficacy of EVT in concurrent multi-territory occlusions (MTVOs) remains unclear. OBJECTIVE To investigate the prevalence, clinical and technical outcomes of concurrent EVT for MTVOs. METHODS Data were included from the Stroke Thrombectomy and Aneurysm Registry (STAR) with 32 stroke centers for EVT performed to treat bilateral anterior or concurrent anterior and posterior circulation occlusions between 2017 and 2021. Patients with MTVO were identified, and propensity score matching was used to compare this group with patients with occlusion in a single arterial territory. RESULTS Of a total of 7723 patients who underwent EVT for acute ischemic stroke, 54 (0.7%) underwent EVT for MTVOs (mean age 69±12.5; female 50%). 28% had bilateral and 72% had anterior and posterior circulations occlusions. The rate of successful recanalization (Thrombolysis in Cerebral Infarction 2b/3), complications, modified Rankin score at 90 days, and mortality was not significantly different between the matched cohorts. Multivariate analysis confirmed that MTVOs were not associated with poor functional outcome, symptomatic intracranial hemorrhage, or longer procedure time. CONCLUSION Compared with EVT for single vessel occlusions, EVT in appropriately selected patients with MTVOs has a similar efficacy and safety profile.
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Affiliation(s)
- Hassan Saad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheila Eshraghi
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ali M Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Feras Akbik
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Makenna Ash
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alice Hsu
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aqueel Pabaney
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ilko Maier
- Department of Neurology, University Medicine Goettingen, Goettingen, Germany
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joon-Tae Kim
- Chonnam National University, Gwangju, Korea (the Republic of)
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Ansaar Rai
- Department of Radiology, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Robert M Starke
- Department of Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Amir Shaban
- Department of Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Isabel Fragata
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | | | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Joshua W Osbun
- Department of Neurosurgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Travis M Dumont
- Department of Surgery, Division of Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
| | - Richard Williamson
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Li Z, Wu S, Zhao S, Li N, Ma W, Jiang G, Liu L, Jing G. Successful mechanical thrombectomy in acute bilateral M1 middle cerebral artery occlusion: a case report and literature review. BMC Neurol 2023; 23:119. [PMID: 36964484 PMCID: PMC10037881 DOI: 10.1186/s12883-023-03173-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/17/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Acute bilateral occlusion of the middle cerebral artery (MCA) is a very rare condition, and most cases are accompanied by a poor prognosis. However, mechanical thrombectomy (MT) for bilateral MCA is challenging. Here, we report a case of acute unilateral MCA occlusion with sequential acute occlusion of the bilateral MCA during intravenous thrombolysis (IVT). We urgently performed bilateral MT of the MCA and effective recanalization. CASE PRESENTATION The patient is a 73-year-old man who complained of a sudden adverse influence on speech and an inability to move his left limb for 2 h. He had a history of paroxysmal atrial fibrillation, but had never used any anticoagulants before. Head and neck computed tomography angiography (CTA) showed embolism in the right M1 MCA. During intravenous alteplase thrombolytic therapy, the patient suddenly became unconscious. Cerebral angiography showed occlusion of the M1 segment of the bilateral MCA in the patients. MT of the bilateral MCA was performed using a combination of a stent retriever and an aspiration catheter with mTici 3 revascularization. On the second day, the patient became conscious, although he had remaining symptoms of speech insufficiency and weakness of the left limb. The mRS score was 2 90 days after the operation. CONCLUSIONS Acute bilateral occlusion of the M1 segment of the MCA is extremely rare and is accompanied by high morbidity and high mortality. Intravenous alteplase thrombolysis can increase the risk of atrial thrombus shedding in patients with atrial fibrillation, so patients with acute bilateral MCA occlusion in the M1 segment chose direct MT or bridging therapy, which remains controversial, and the sequence of MT remains to be discussed. Nevertheless, early endovascular treatment can decrease the morbidity and mortality of such patients.
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Affiliation(s)
- Zhiqiang Li
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China
| | - Shuhui Wu
- Department of Traditional Chinese Medicine, Liaocheng Third People's Hospital, No.62, Weiyu Road, Shandong, Liaocheng City, 252000, China
| | - Shuzhi Zhao
- Department of Neurology, Liaocheng Third People's Hospital, No.62, Weiyu Road, Shandong, Liaocheng City, 252000, China
| | - Ning Li
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China
| | - Weibin Ma
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China
| | - Guisheng Jiang
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China
| | - Lingling Liu
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China.
| | - Guoxian Jing
- Department of Neurology, Liaocheng People's Hospital, NO. 67, West Dongchang Road, Shandong, Liaocheng City, 252000, China.
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Mai DT, Vu DL, Nguyen QA, Huu AN, Nguyen MA, Dao VP. Simultaneous mechanical thrombectomy for bilateral acute internal carotid artery occlusion. Radiol Case Rep 2021; 17:142-146. [PMID: 34820038 PMCID: PMC8601968 DOI: 10.1016/j.radcr.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/01/2022] Open
Abstract
Acute bilateral internal carotid occlusion was a very rare disease with a very poor prognosis. Clinical case reports according to the literature showed that mechanical thrombectomy was the most optimal treatment. We reported a clinical case of successful treatment with simultaneous thrombectomy in both occluded carotid arteries. A 62-year-old woman was admitted at our hospital within three hours of stroke onset secondary to an acute simultaneously bilateral carotid artery occlusion. On admission, her NIHSS (National Institutes of Health Stroke Scale) was 32. Non-contrast computed tomography right after that showed hyperacute infarction lesions in both hemispheres with right inferior temporal and insular cortex (Alberta Stroke Program Early CT Score - ASPECTS 8) and left putamen (ASPECTS 9). Her medical history included paroxysmal atrial fibrillation, prior ischemic stroke, pacemaker due to sick sinus syndrome. Her pre-stroke modified Rankin Scale score was 0 that she was fully recovered from previous stroke 4 months ago thanks to successful thrombectomy of the right internal carotid arteries (ICA). This time, the patient underwent again the simultaneous bilateral mechanical thrombectomy of both occluded ICA. The complete recanalization achieved on both sides with recanalization level of TICI-3 (thrombolysis in cerebral infarction) only in 38 mins after the groin puncture. She showed dramatic recovery and was discharged on day 28 with a Rankin Scale score of 2. Mechanical thrombectomy on bilateral ICA performed simultaneously will helps shorten the reperfusion time compared to the alternative one and thus, provides a better prognosis in acute ischemic stroke.
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Affiliation(s)
- Duy Ton Mai
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Dang Luu Vu
- Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
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Florian IA, Lupan I, Sur L, Samasca G, Timiș TL. To be, or not to be… Guillain-Barré Syndrome. Autoimmun Rev 2021; 20:102983. [PMID: 34718164 DOI: 10.1016/j.autrev.2021.102983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
Guillain-Barré Syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis on a global scale, being an autoimmune disorder wherein demyelination of the peripheral nerves occurs. Its main clinical features are a symmetrical ascending muscle weakness with reduced osteotendinous reflexes and variable sensory involvement. GBS most commonly occurs after an infection, especially viral (including COVID-19), but may also transpire after immunization with certain vaccines or in the development of specific malignancies. Immunoglobulins, plasmapheresis, and glucocorticoids represent the principal treatment modalities, however patients with severe disease progression may require supportive therapy in an intensive care unit. Due to its symptomology, which overlaps with numerous neurological and infectious illnesses, the diagnosis of GBS may often be misattributed to pathologies that are essentially different from this syndrome. Moreover, many of these require specific treatment methods distinct to those recommended for GBS, in lack of which the prognosis of the patient is drastically affected. Such diseases include exposure to toxins either environmental or foodborne, central nervous system infections, metabolic or serum ion alterations, demyelinating pathologies, or even conditions amenable to neurosurgical intervention. This extensive narrative review aims to systematically and comprehensively tackle the most notable and challenging differential diagnoses of GBS, emphasizing on the clinical discrepancies between the diseases, the appropriate paraclinical investigations, and suitable management indications.
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Affiliation(s)
- Ioan Alexandru Florian
- Department of Neurology, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania, Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania.
| | - Lucia Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients. Radiol Oncol 2021; 55:409-417. [PMID: 34598375 PMCID: PMC8647787 DOI: 10.2478/raon-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background All the patients with suspected stroke are directed to whole-brain CT scan. The purpose of this scan is to look for early features of ischemia and to rule out alternative diagnoses than stroke. In case of ischemic stroke, CT diagnostics (including CT angiography) is used mainly to locate the occlusion and its size, while the Hounsfield Units (HU) values of the thrombus causing the stroke are usually overlooked on CT scan or considered not important. The aim of this study was to demonstrate that the HU value is relevant and can help in better treatment planning. Patients and methods There were 25 patients included in the study, diagnosed with ischemic stroke in the middle cerebral artery (MCA) territory. In all patients, systemic thrombolysis was not successful and the mechanical recanalization was needed. The retrieved thrombi were also analyzed histologically for the determination of red blood cells (RBC) proportion. CT of the proximal MCA (M1) segment was analyzed for average HU value and its variability both in the occluded section and the symmetrical normal site. These CT parameters were then statistically studied for the possible correlations with different clinical, histological and procedure parameters using the Linear Regression and the Pearson correlation coefficient. Results Relevant positive correlations were found between average HU value of thrombus and outcome modified Rankin Scale (mRS), initial mRS, number of passes with thrombectomy device as well as RBC proportion. Conclusions Results of the present study suggest that measured HU values in CT images of the cerebral thrombi may help in the assessment of thrombus compaction and therefore better treatment planning.
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Beutler BD, Rangaswamy R, Bruno AJ, Tabaac BJ. Acute bilateral internal carotid artery occlusion: A novel approach to management of a catastrophic clinical entity. Clin Imaging 2021; 76:166-174. [PMID: 33636514 DOI: 10.1016/j.clinimag.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute bilateral internal carotid artery occlusion (ABICAO) represents a rare but potentially-lethal clinical entity. Guidelines for management remain to be established. However, emergent intervention is vital to prevent loss of brainstem reflexes and death. PURPOSE We describe two patients who presented with ABICAO and detail a novel management approach with carotid angioplasty and stent placement. In addition, we review the literature on ABICAO. RESULTS Two patients presented within a two-week period with marked neurologic deficits. Imaging studies showed ABICAO. The first patient was initially treated with tissue plasminogen activator. No improvement occurred after two days, prompting the medical team to attempt urgent carotid artery angioplasty and stenting. However, the patient continued to deteriorate and died shortly after the intervention. The second patient underwent emergent carotid artery angioplasty and stenting within hours of presentation and recovered with only mild residual neurologic deficits. CONCLUSION Further research on ABICAO management is required to establish clinical practice guidelines. However, as evidenced by our two patients, endovascular thrombectomy should be performed as early as possible in appropriate candidates; an unfavorable outcome may occur if treatment is delayed. Based on the limited available data, emergent angioplasty and stenting should be considered a first-line intervention for patients presenting with this rare and oft-lethal event.
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Affiliation(s)
- Bryce D Beutler
- University of Southern California, Keck School of Medicine, Department of Radiology, Los Angeles, CA, USA.
| | - Rajesh Rangaswamy
- Reno Radiological Associates, Reno, NV, USA; Renown Regional Medical Center, Reno, NV, USA; University of Nevada, Reno School of Medicine, Reno, NV, USA
| | | | - Burton J Tabaac
- Renown Regional Medical Center, Reno, NV, USA; University of Nevada, Reno School of Medicine, Reno, NV, USA; Renown Health, Acute Care Neurology Division, Reno, NV, USA
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Huang J, Liu H, Chen H, Yuan L, Fang L, Yang Z. Acute Bilateral Internal Carotid Artery Occlusion Presenting with Symmetric Cortical Infarctions Exhibits Dramatic Improvement After Mechanical Thrombectomy. World Neurosurg 2020; 141:149-152. [PMID: 32544620 DOI: 10.1016/j.wneu.2020.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute bilateral internal carotid artery (ICA) occlusion has rarely been reported to exhibit an improvement in prognosis. Herein, we report a case of acute bilateral ICA occlusion presenting with bilateral symmetric cortical and basal-ganglia infarctions that exhibited dramatic improvement after a mechanical thrombectomy. CASE DESCRIPTION The patient was a 72-year-old man with a history of hypertension who presented with a coma and quadriplegia during sleep and experienced moderate vomiting and diarrhea the day before admission to our hospital. Neurologic examination revealed that the patient was in a coma (National Institutes of Health Stroke Scale 35). A brain computed tomography (CT) scan showed a hypodense lesion in the bilateral frontal cortex. An emergency cerebral angiography demonstrated complete occlusion of the bilateral ICA. Subsequently, a mechanical thrombectomy of the bilateral ICA was successfully performed. At a 3-month follow-up, the patient had residual slight aphasia and quadriparesis (National Institutes of Health Stroke Scale 16). CONCLUSIONS Bilateral ICA occlusion should be considered if a patient presents with a coma, quadriplegia, and symmetric cortical infarctions. In such a case, a bilateral mechanical thrombectomy may represent a potential treatment for improving the prognosis of the affected patient.
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Affiliation(s)
- Jinbo Huang
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Hailing Liu
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Hai Chen
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Li Yuan
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Ling Fang
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China
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