Sudden Coma from Acute Bilateral M1 Occlusion: Successful Treatment with Mechanical Thrombectomy

Dietrich, U.; Graf, Tilmann; Schäbitz, Wolf‐Rüdiger

doi:10.1159/000362160

Cited by 18 publications

(12 citation statements)

References 13 publications

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“…Furthermore, treatment prioritized on the side on which a main etiological factor for neurological deficits is present may lead to a favorable outcome because of amelioration of clinical symptoms. 15,16) In the present patient, it was impossible to evaluate acute or subacute occlusion on both sides based on angiography. The left penumbra area was relatively large, and symptoms on the left side, suspected as predominant hemisphere, may have caused aphasia and consciousness disorder.…”

Section: Discussionmentioning

confidence: 72%

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

Tsujimoto

Ikeda

Otsuka

et al. 2020

JNET

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We report a survived case of acute bilateral internal carotid artery occlusion successfully treated by mechanical thrombectomy. Case Presentation: The patient was an 82-year-old right-handed man. Sudden consciousness disturbance and aphasia appeared, and cranial magnetic resonance angiography (MRA) revealed bilateral internal carotid artery occlusion. Cerebral angiography demonstrated occlusion between the cervical and cavernous portions of the bilateral internal carotid artery, and the growth of collateral circulation to the areas where the bilateral internal carotid artery perfused. We performed mechanical thrombectomy first on the left side, which was the main cause of his symptoms and relatively wide ischemic penumbra, and achieved recanalization of the bilateral internal carotid artery and suppressed extensive enlargement of the infarction. Conclusion: Acute bilateral internal carotid artery occlusion requires an optimal treatment strategy based on the clinical symptoms and preoperative imaging. Keywords▶ internal carotid artery, occlusion, bilateral, thrombectomy, acute ischemic stroke Case Presentation The patient was an 82-year-old right-handed man with a history of rectal cancer. He had smoked 20 cigarettes/day and consumed alcohol every day. He was transferred to our hospital with dyspnea. While preparations were made for admission due to heart failure related to dilated cardiomyopathy, consciousness disorder and aphasia suddenly appeared. The Glasgow Coma Scale score was E2V2M5 and partial conjugate deviation to the left side was noted. The manual muscle testing scores were 3/5 for the bilateral upper limbs and right lower limb and 4/5 for the left lower limb, suggesting incomplete paralysis dominantly in the right side. Severe aphasia and unilateral carelessness were also observed. The National Institute of Health Stroke Scale (NIHSS) score was 20. Diffusion-weighted magnetic resonance imaging (MRI-DWI) at 140 minutes after onset revealed acute cerebral infarction of the area perfused by the bilateral middle cerebral arteries and right posterior cerebral artery. The DWI-Alberta Stroke Programme Early CT Score (ASPECTS) was 10 at both sides (Fig. 1A). Fluid-attenuated inversion recovery (FLAIR) imaging demonstrated little signal changes in the infarction area (Fig. 1B). Although occlusion of the bilateral internal This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Section: Discussionmentioning

confidence: 72%

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

Tsujimoto

Ikeda

Otsuka

et al. 2020

JNET

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“…[12][13][14][15] Mortality is almost universal, although an early and successful recanalization by mechanical thrombectomy might avert the catastrophic outcome. 16 In addition to triple antiphospholipid antibody positivity, our patient presented with severe hyperglycemia that may lead to hyperviscosity and worsening of the antiphospholipid antibody-associated hypercoagulable state. 17 The rare coexistence of these two clinical conditions (increased titers of antiphospholipid antibodies and hyperglycemia) resulted in a severe thromboembolic burden that was captured by a very high MES burden on TCCDS monitoring.…”

Section: Case Presentationmentioning

confidence: 82%

“…Acute bilateral large vessel occlusion (either middle cerebral arteries or intracranial internal carotid arteries) is very rare and usually results in immediate loss of consciousness and quadriplegia followed soon by decerebrate posturing and loss of brainstem reflexes, mimicking severe brainstem stroke . Mortality is almost universal, although an early and successful recanalization by mechanical thrombectomy might avert the catastrophic outcome …”

Section: Case Presentationmentioning

confidence: 99%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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Acute multi‐territory, embolic cerebral infarctions are often associated with serious underlying clinical conditions including the presence of highly “active” emboligenic sources causing that in turn may result in high early recurrence rates. Prompt diagnosis, risk stratification, and treatment are substantial for the prevention of subsequent embolization that would result in further clinical deterioration. Among other clinical investigations, transcranial Doppler (TCD) monitoring is highly efficacious for the detection of microembolic signals (MES) that correspond to microthrombi entering the intracranial circulation. The presence and burden of MES, especially in multiple intracranial arteries, is clearly associated with an increased risk of symptomatic, recurrent embolization, and thus can justify a more aggressive treatment approach (clopidogrel load followed by dual antiplatelet therapy or alternatively therapeutic dose of low‐molecular‐weight heparin). In this narrative review, we discuss the most important causes of multi‐territory embolic ischemic strokes and also underscore the utility of TCD as a noninvasive tool for the diagnosis, risk stratification, and treatment.

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“…To the best of our knowledge, there are only six reports about mechanical thrombectomy being performed for acute bilateral ICA and/or MCA occlusions. [5][6][7][8][9] A 2014 report by Dietrich et al describes two M1 MCA thrombectomy procedures being performed in sequence. Aspiration was attempted without success, so multiple passes with…”

Section: Discussionmentioning

confidence: 99%

“…Acute embolic bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion leads to sudden comas with poor prognoses. [1][2][3][4][5][6][7][8][9] The reported incidence of this condition in stroke patients treated with intravenous or intra-arterial therapy is 0.34%. 8 There are few reports on the endovascular treatment (mechanical recanalization -thrombectomy) of this rare condition.…”

Section: Introductionmentioning

confidence: 99%

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

Jeromel

Milošević

Oblak

2020

Radiology and Oncology

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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.

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Sudden Coma from Acute Bilateral M1 Occlusion: Successful Treatment with Mechanical Thrombectomy

Cited by 18 publications

References 13 publications

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

A Survived Case of Acute Bilateral Internal Carotid Artery Occlusion Treated by Mechanical Thrombectomy

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

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

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