2020 Volume 42 Issue 6 Pages 553-559
Background: Bilateral large vessel occlusion is very rare and mortality is high. We report a case of bilateral large vessel (right internal carotid artery and left middle cerebral artery) occlusion treated by simultaneous bilateral mechanical thrombectomy and intravenous alteplase administration. Case presentation: A 69-year-old man not treated by atrial fibrillation was presented with mild disturbance of consciousness, right conjugated deviation, left hemiplegia, and aphasia. He arrived at the hospital 46 min after the onset with an National Institute of Health Stroke Scale (NIHSS) score of 28. DWI showed high intensity in bilateral cerebral hemispheres, and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was 7/11 in the right hemisphere and 10/11 in the left. MRA showed right internal carotid artery and left M1 occlusion. We treated the right side first because it had a lower ASPECTS score and the main symptoms were due to right cerebral ischemia. Mechanical thrombectomy was performed and bilateral recanalization was achieved (right side modified TICI 3, left side 2a). On the day after onset, MRI did not show progression of cerebral infarction compared with the initial MRI, and NIHSS decreased to 1. After a short rehabilitation period, he was discharged. Conclusion: Bilateral large vessel occlusion is more likely to be severe than unilateral occlusion. However, as in this case, if the treatment order (right or left) is properly selected and the procedure can be quickly performed, a good prognosis can be expected.
