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

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

Radiology and Oncology
Volume 54 (2020): Issue 2 (June 2020)
By: Miran Jeromel,  Zoran V Milosevic and  Janja Pretnar Oblak  
Open Access
|Mar 2020

Figures & Tables

Figure 1

Initial imaging workup upon arrival at the general hospital. CT angiography (CTA) shows right M1 occlusion (arrow).
Initial imaging workup upon arrival at the general hospital. CT angiography (CTA) shows right M1 occlusion (arrow).

Figure 2

(A) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer to the tertiary institution. There were still no signs of ischaemic brain damage in the right cerebral hemisphere but there were subtle signs of stroke in the left middle cerebral artery (MCA) territory (white line delineates loss of cortical grey matter – white matter differentiation in the frontoparietal lobe with sulcal effacement). (B) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer. CT angiography (CTA) showed persistent right M1 occlusion (black arrow) but also left carotid “T” occlusion (white arrow). (C) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer. CT perfusion imaging (CTP) showed a penumbra in the right MCA territory (black circle) and irreversible brain damage in the left MCA territory (white circle).
(A) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer to the tertiary institution. There were still no signs of ischaemic brain damage in the right cerebral hemisphere but there were subtle signs of stroke in the left middle cerebral artery (MCA) territory (white line delineates loss of cortical grey matter – white matter differentiation in the frontoparietal lobe with sulcal effacement). (B) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer. CT angiography (CTA) showed persistent right M1 occlusion (black arrow) but also left carotid “T” occlusion (white arrow). (C) Control images taken in the general hospital after clinical deterioration during intravenous thrombolysis and before the transfer. CT perfusion imaging (CTP) showed a penumbra in the right MCA territory (black circle) and irreversible brain damage in the left MCA territory (white circle).

Figure 3

(A) Digital subtraction angiography (DSA) at the beginning of mechanical recanalization. Right internal carotid contrast injection confirming right M1 occlusion. (B) DSA at the beginning of mechanical recanalization. Left side contrast injection showing complete spontaneous recanalization of the carotid “T” occlusion with thrombembolar distal migration (occlusion of the proximal M2 segment of the major MCA branch) (arrow).
(A) Digital subtraction angiography (DSA) at the beginning of mechanical recanalization. Right internal carotid contrast injection confirming right M1 occlusion. (B) DSA at the beginning of mechanical recanalization. Left side contrast injection showing complete spontaneous recanalization of the carotid “T” occlusion with thrombembolar distal migration (occlusion of the proximal M2 segment of the major MCA branch) (arrow).

Figure 4

(A) Digital subtraction angiography (DSA) after mechanical recanalization. Right M1 mechanical recanalization (aspiration device) led to complete flow restoration. (B) MR diffusion weighted imaging (DWI) scan taken 6 days after mechanical recanalization: complete salvage of the affected right middle cerebral artery (MCA) brain parenchyma (recanalization at 7 hours after stroke onset). In contrast, subsequent persistent left M2 occlusion without collateral flow resulted in significant stroke within 3 hours after stroke onset.
(A) Digital subtraction angiography (DSA) after mechanical recanalization. Right M1 mechanical recanalization (aspiration device) led to complete flow restoration. (B) MR diffusion weighted imaging (DWI) scan taken 6 days after mechanical recanalization: complete salvage of the affected right middle cerebral artery (MCA) brain parenchyma (recanalization at 7 hours after stroke onset). In contrast, subsequent persistent left M2 occlusion without collateral flow resulted in significant stroke within 3 hours after stroke onset.

Comparing 6 reported cases of mechanical thrombectomy in acute bilateral ICA and/or MCA occlusions

Author, (Year),Sex/ageSite of occlusionMechanicalClinical
referenceClinical presentation(years)ICAMCAthrombectomy (technique)outcome
Dietrich et al. (2014)5left hemiparesis, progressing to comaM/72-+ (M1)aspiration+stent- retrieverminor deficit
Pop et al. (2014)6impaired consciousnessF/78++ (M2)stent-retrieverno deficit
Pop et al.(2014)6right sided weaknessF/66++ (M1)stent-retrieversevere deficit
Braksick et al. (2018)7comaF/76-+ (M1)- (no data)coma
Larrew (2019) et al. 8coma- (no data) / middle age++ -aspirationfatal
Storey et al. 2019)9hemiparesis / hemiplegiaF/64++ (M1,M2)aspiration+stent-retrieverminor deficit
DOI: https://doi.org/10.2478/raon-2020-0017 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
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Language: English
Page range: 144 - 148
Submitted on: Jan 19, 2020
|
Accepted on: Mar 5, 2020
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Published on: Mar 26, 2020
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
acute bilateral stroke,
mechanical recanalization,
thrombectomy
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2020 Miran Jeromel, Zoran V Milosevic, Janja Pretnar Oblak, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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