Mechanical recanalization for acute bilateral cerebral artery occlusion – literature overview with a case

Abstract

BackgroundAcute bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion is extremely rare and associated with poor clinical outcomes. There are only a few reports in the literature about mechanical thrombectomy being performed for acute bilateral occlusions. The treatment strategies and prognoses (clinical outcomes) are therefore unclear.MethodsA systematic review of the literature was performed through several electronic databases with the following search terms: acute bilateral stroke, mechanical recanalization and thrombectomy.ResultsIn the literature, we identified five reports of six patients with bilateral ICA and/or MCA occlusion treated with mechanical recanalization. Additionally, we report our experience with a subsequent contralateral large brain artery occlusion during intravenous thrombolytic therapy, where the outcome after mechanical thrombectomy was not dependent on the time from stroke onset but rather on the capacity of collateral circulation exclusively.ConclusionsAcute bilateral cerebral (ICA and/or MCA) occlusion leads to sudden severe neurological deficits (comas) with unpredicted prognoses, even when mechanical recanalization is available. As the collateral capacity seems to be more important than the absolute time to flow restoration in determining the outcomes, simultaneous thrombectomy by itself probably does not lead to improved functional outcomes.

Endovascular Recanalization and Carotid Stenting: The New Approach to Restore Cerebral Perfusion during Aortic Dissection

“…We have not found a literature description of bilateral interventions in cases of cerebral occlusion in patients with a TAAD. However, several case reports have been published after a successful technical revascularization of bilateral ICA thrombotic occlusion, which demonstrate both positive and unfavorable outcomes [23][24][25][26]. Studies suggest that the results of mechanical thrombectomy and stenting may depend on the patient's clinical condition, collateral circulation, and localization of occlusion [26][27][28][29].…”

“…However, several case reports have been published after a successful technical revascularization of bilateral ICA thrombotic occlusion, which demonstrate both positive and unfavorable outcomes [23][24][25][26]. Studies suggest that the results of mechanical thrombectomy and stenting may depend on the patient's clinical condition, collateral circulation, and localization of occlusion [26][27][28][29]. However, one of the main factors influencing the CM outcome due to the TAAD is the time that was taken for reperfusion [30].…”

Simultaneous mechanical thrombectomy for bilateral acute internal carotid artery occlusion

“…The studies [6] , [7] , [8] , [9] suggest that the outcomes of mechanical thrombectomy may depend on the time window from onset, clinical status, collateral circulation, and location of vessel occlusion. One of the factors related to the outcome of recovery is that the shorter the femoral revascularization time is, the more effective it is.…”

Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients

“… 23 Outcome after mechanical thrombectomy can be more dependent on the capacity of collateral circulation than on the time from stroke onset. 24 However, time still plays an important role in saving tissue at risk (penumbra). In addition, the longer time taken till resolving the occlusion, the thrombus can retract further and therefore becomes more compact with a low serum content.…”