BILATERAL MIDDLE CEREBRAL ARTERY STROKE TREATED WITH DOUBLE THROMBECTOMY. REPORT OF TWO CASES.

BACKGROUND:
Bilateral middle cerebral artery (MCA) occlusion in patients with acute ischemic stroke is an extremely rare entity whose treatment has not been established. 

METHODS:
We report two cases of acute bilateral MCA occlusion treated with endovascular therapy at our center.

CASES REPORT:
Case1: A 68 year-old female with history of atrial fibrillation treated with antiplatelets presented with impaired consciousness, speech disorder and right-sided hemiparesis (NIHSS:12) with unknown onset time. A multiparametric CT showed a total occlusion of the proximal M1 segment of the left MCA and another occlusion in the proximal right M2 segment. Early recanalization of the left MCA was achieved but the right MCA remained occluded despite multiple stent-retriever passes. A CT performed 24 hours after the procedure demonstrated a bilateral cerebral infarction with hemorrhagic transformation (IH2). Three months after the stroke she was dependent in daily life activities (mRs4).
Case2: A 82 year-old female with history of hypertension, hypercholesterolemia and diabetes under antiplatelet therapy presented with acute onset of aphasia and left-sided hemiparesis (NIHSS:16). A baseline CT was normal and intravenous thrombolysis was started without neurological improvement. A CT-angiography showed a double artery occlusion (left M1 segment and right carotid T). Both arteries were recanalized within six hours of stroke onset but a MRI showed an extensive infarction and the patient finally died of respiratory complications.

CONCLUSIONS:
Stroke due to acute bilateral MCA occlusion is a rare entity difficult to diagnose with unknown prognostic factors and high morbimortality despite successful treatment. We have not found any similar references in literature.