Acute Bilateral Internal Carotid Artery Occlusion Presenting with Symmetric Cortical Infarctions Exhibits Dramatic Improvement After Mechanical Thrombectomy

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.