TY - JOUR T1 - Facing the crossroads: acute stroke with bilateral carotid occlusion JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-229638 VL - 12 IS - 6 SP - e229638 AU - Guilherme Jose Agnoletto AU - Manuel F Granja AU - Ricardo Hanel AU - Amin Aghaebrahim Y1 - 2019/06/01 UR - http://casereports.bmj.com/content/12/6/e229638.abstract N2 - 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. ER -