PT  - JOURNAL ARTICLE
AU  - Guilherme Jose Agnoletto
AU  - Manuel F Granja
AU  - Ricardo Hanel
AU  - Amin Aghaebrahim
TI  - Facing the crossroads: acute stroke with bilateral carotid occlusion
AID  - 10.1136/bcr-2019-229638
DP  - 2019 Jun 01
TA  - BMJ Case Reports
PG  - e229638
VI  - 12
IP  - 6
4099  - http://casereports.bmj.com/content/12/6/e229638.short
4100  - http://casereports.bmj.com/content/12/6/e229638.full
SO  - BMJ Case Reports2019 Jun 01; 12
AB  - 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.