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Facing the crossroads: acute stroke with bilateral carotid occlusion
  1. Guilherme Jose Agnoletto,
  2. Manuel F Granja,
  3. Ricardo Hanel and
  4. Amin Aghaebrahim
  1. Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  1. Correspondence to Dr Ricardo Hanel, rhanel{at}


We present a previously unreported case of endovascular therapy in the acute setting of ischaemic stroke in a patient with bilateral carotid occlusion (BCO). A 54-year-old man presents with sudden onset of right-sided weakness, difficulty speaking and left-sided gaze, with National Institute of Health Stroke Scale of 22 and no abnormalities on plain CT head. CT angiography showed BCO and CT perfusion demonstrated extensive area of penumbra in both hemispheres. The patient was sent for cerebral angiography that confirmed BCO. Since symptomatology was a left middle cerebral arteries syndrome, decision was made to angioplasty and stent the left internal carotid artery emergently, which was performed successfully and the patient had complete resolution of symptoms. Acute stroke with BCO represents a challenge in decision making regarding acute management and individual assessment must be made.

  • stroke
  • neuroimaging
  • interventional radiology
  • neurosurgery

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  • Contributors GJA, AA and RH were responsible for study concept and design. The authors contributed to acquisition of the data and were responsible for analysis and interpretation of the data and drafting of the manuscript. AA and RH contributed to critical revision of the manuscript for important intellectual content. GJA and MFG were responsible for administrative, technical and material support. AA and RH contributed to study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RH is a consultant for Covidien, Stryker, Codman and Microvention.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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