Anesthetic Considerations in Endovascular Stroke Treatment: A Clinical Case Study

Acute embolic sequential bilateral occlusion is an extremely rare event and can be difficult to detect during mechanical thrombectomy (MT) under general anesthesia (GA). We describe a male with vascular risk factors who was admitted two hours after the sudden onset of aphasia, right-sided central facial palsy, homonymous hemianopsia, and ipsilateral hemiplegia/hypoesthesia. Thrombolytic intravenous treatment was started, and the patient had an allergic reaction and required intubation. MT was performed under GA, and after the first recanalization, a new contralateral occlusion was detected during the angiographic evaluation, which was also recanalized. Furthermore, we systematically review the literature to identify the prevalence of cases with sequential occlusions described so far and to understand the role of GA in these challenging cases. This allows interventional neuroradiologists to detect such subtle signs, since prompt detection of "de novo" contralateral occlusions with subsequent immediate recanalization is the only way to prevent clinical deterioration in these cases.