Mechanical Thrombectomy for Bihemispheric Infarction Caused by Acute Unilateral Internal Carotid Artery Occlusion in a Patient with Contralateral Chronic Carotid Occlusion: A Case Report

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  • Fujiwara Hidemoto
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Tsuchiya Naoto
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Saito Taiki
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Ohkura Ryota
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan
  • Yoshimura Junichi
    Department of Neurosurgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan

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<p>Objective: We report a patient with acute bihemispheric infarction who underwent mechanical thrombectomy.</p><p>Case Presentation: A 76-year-old man suddenly developed coma and quadriplegia. Brain MRI and MRA revealed acute bihemispheric infarction due to occlusions of both the internal carotid arteries (ICAs). According to the DSA findings, we considered the left ICA as chronic occlusion and the right as acute. Mechanical thrombectomy for the right ICA occlusion was performed. Total recanalization was achieved using a stent retriever 181 minutes after onset. The left hemisphere was perfused by cross circulation through the anterior communicating artery, but the symptoms did not improve. MRI the day after thrombectomy showed extensive bihemispheric infarction. Recanalization for the bilateral hemispheres was maintained, although the left ICA remained occluded. He died 2 months later due to gastrointestinal bleeding.</p><p>Conclusion: Acute bihemispheric infarction due to occlusions of both ICAs is a rare entity. The symptoms are very severe and the therapeutic time window is extremely short because of absent collateral pathways. We should consider pre-existing carotid occlusive disease, determine whether the occlusions are acute or chronic, and perform prompt therapy. Further investigation is warranted to obtain a better outcome.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 16 (5), 270-276, 2022

    特定非営利活動法人 日本脳神経血管内治療学会

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