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Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature

Published inInterventional neuroradiology, 15910199231171806
First online date2023-05-02
Abstract

Background: Bilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate.

Objective: To assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke.

Methods: We present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature.

Results: Two patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients.

Conclusions: In patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

Keywords
  • Stroke
  • Stentriever
  • Thromboaspiration
Citation (ISO format)
BERNAVA, Gianmarco et al. Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature. In: Interventional neuroradiology, 2023, p. 15910199231171806. doi: 10.1177/15910199231171806
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ISSN of the journal1591-0199
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Creation05/09/2023 9:20:52 AM
First validation05/25/2023 5:45:08 AM
Update time05/25/2023 5:45:08 AM
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