Abstract: Introduction: a case report of successful treatment of an extremely rare pathology (0,27-0,34%) - acute occlusion of both internal carotid arteries (ICA) is presented. Aim: was to show possibilities of endovascular surgery in the diagnosis and treatment of acute ischemic stroke (AIS) in patients with bilateral acute ICA occlusion. Materials and methods: a 38-year-old patient was hospitalized by ambulance with the diagnosis of AIS. Multispiral computed tomography (MSCT) revealed left ICA occlusion in the C2-C5 segment. Selective angiography of ICA was performed: right ICA - non-occlusive thrombosis C2-C3 segments; left ICA - thrombotic occlusion in C1 segment. Results: thrombaspiration was performed from the left ICA and right ICA; full recovery of antegrade cerebral blood flow was achieved in both ICA, according to the modified treatment in cerebral infarction score (mTICI) - 3. Patient was discharged after 28 days. At the time of discharge, the modified Rankin Scale (mRS) score was 3. 6 months after discharge mRS was 1. Conclusions: Selective angiography of both ICA in a patient with AIS enabled to detect right ICA thrombosis not detected by MCT, which in its turn changed the treatment tactics of the patient. Aspiration thromebctomy from both internal carotid arteries allowed to achiev full recovery of antergrade cerebral blood flow of both internal carotid arteries. References 1. The top ten cuases of death, WHO fact sheets 2020. https://www.who.int/ru/news-room/fact-sheets/detail/the-top-10-causes-of-death 2. Shapoval IN, Nikitina SYu, Ageeva LI, et al. Zdravoochranenie v Rossii. 2019 [In Russ]. https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2019.pdf 3. Aigner A, Grittner U, Rolfs A, et al. Contribution of established stroke risk factors to the burden of stroke in young adults. Stroke. 2017; 48: 1744-1751. https://doi.org/10.1161/STROKEAHA.117.016599 4. Gafarova AV, Gromova EA, Panov DО, et al. Social support and stroke risk: an epidemiological study of a population aged 25-64 years in Russia/Siberia (the WHO MONICA-psychosocial program). Neurology, Neuropsychiatry, Psychosomatics. 2019; 11(1): 12-20 [In Russ]. https://doi.org/10.14412/2074-2711-2019-1-12-20 5. Putaala J. Ischemic Stroke in Young Adults. Continuum. 2020; 26(2): 386-414. https://doi.org/10.1212/CON.0000000000000833 6. Si Y, Xiang S, Zhang Y. et al. Clinical profile of etiological and risk factors of young adults with ischemic stroke in West China. Clinical Neurology and Neurosurgery. 2020; 193. https://doi.org/10.1016/j.clineuro.2020.105753 7. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology. 2018; 17(9): 790-801. https://doi.org/10.1016/s1474-4422(18)30233-3 8. Chi X, Zhao R, Pei H, et al. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med. 2020; 3(1): 53-59. https://doi.org/10.1002/agm2.12105 9. Dietrich U, Graf T, Sch?bitzb WR. Sudden coma from acute bilateral M1 occlusion: successful treatment with mechanical thrombectomy. Case Rep Neurol. 2014; 6: 144-148. https://doi.org/10.1159/000362160 10. Pop R, Manisor M, Wolff V. Endovascular treatment in two cases of bilateral ischemic stroke. Cardiovasc Intervent Radiol. 2014; 37: 829-834. https://doi.org/10.1007/s00270-013-0746-4 11. Larrew T, Hubbard Z, Almallouhi E.et al. Simultaneous bilateral carotid thrombectomies: a technical note. Oper Neurosurg. 2019; 5(18): 143-148. https://doi.org/10.1093/ons/opz230 12. Storey C, Lebovitz J, Sweid A, et al. Bilateral mechanical thrombectomies for simultaneous MCA occlusions. World Neurosurg. 2019; 132: 165-168. https://doi.org/10.1016/j.wneu.2019.08.236 13. Braksick SA, Robinson CP, Wijdicks EFM. Bilateral middle cerebral artery occlusion in rapid succession during thrombolysis. Neurohospitalist. 2018; 8: 102-103. https://doi.org/10.1177/1941874417712159 14. Jeromel M, Milosevic Z, Oblak J. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a case. Radiology and Oncology. 2020; 54(2): 144-148. https://doi.org/10.2478/raon-2020-0017
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Abstract: Contrast-induced encephalopathy is a rare complication of endovascular injection of contrast agent. Aim: was to analyze available medical literature data, concerning the contrast-induced encephalopathy prevalence, etiology and pathogenesis, clinical and imaging manifestation. Materials and methods: publications with key words «contrast-induced encephalopathy» were selected in Pubmed (wwwpubmed.com). From 34 articles, 15 full-text articles with avaliable description of contrast-induced encephalopathy were selected. We analyzed cases of contrast-induced encephalopathy described in literature, presented main causes and pathogenesis, clinical manifestation and imaging findings, prophylaxis and treatment. Results: development of this complication could be observed after injection of contrast agent into lumen either cerebral arteries or extracerebral ones. Based on the literature analysis, two main types of contrast-induced encephalopathy described: stochastic (accidental) and deterministic (predefined). Conclusion: contrast-induced encephalopathy recognition, differential diagnostic with stroke and intracranial hemorrhage allow making correct prognosis and getting an adequate treatment tactics, when everything is done promptly. References 1. Baik S.K. et al. Immediate CT findings following embolization of cerebral aneurysms: suggestion of blood-brain barrier or vascular permeability change. Neuroradiology. 2008 Mar;50(3):259-266. 2. Yu J.; Dangas G. Commentary: New insights into the risk factors of contrast-induced encephalopathy. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2011 Aug;18(4):545-546. 3. Junck L.; Marshall W.H. Neurotoxicity of radiological contrast agents. Ann. Neurol. 1983 May;13(5):469-484. 4. Yan J. Ramanathan V. Severe encephalopathy following cerebral arteriogram in a patient with end-stage renal disease. Seminars in dialysis. 2013 Mar-Apr; 26(2):203-207. 5. Uchiyama Y et al. Blood brain-barrier disruption of nonionic iodinated contrast medium following coil embolization of a ruptured intracerebral aneurysm. AJNR Am.J. Neuroradiol. 2004 Nov-Dec;25(10):1783-1786. 6. Leong S. Fanning N.F. Persistent neurological deficit from iodinated contrast encephalopathy following intracranial aneurysm coiling. A case report and review of the literature. Interv. Neuroradiol. 2012 Mar;18(1):33-41. 7. Heyman S.N. et al. Radiocontrast agents induce endothelin release in vivo and in vitro. J. Am. Soc. Nephrol. 1992 Jul;3(1):58-65. 8. Stanimirovic D.B. et al. Arachidonic acid release and permeability changes induced by endothelins in human cerebromicrovascular endothelium. Acta Neurochir Suppl (Wien). 1994;60:71-75. 9. Touhami S. et al. Everolimus-induced posterior reversible encephalopathy syndrome and bilateral optic neuropathy after kidney transplantation. Transplantation. 2014 Dec 27;98(12):e102-104. 10. Nishijima H. et al. Asymmetric Posterior Reversible Encephalopathy Syndrome due to Hypertensive Encephalopathy. Internal. medicine (Tokyo, Japan). 2015;54(8):993-994. 11. Wagih A. et al. Posterior Reversible Encephalopathy Syndrome (PRES): Restricted Diffusion does not Necessarily Mean Irreversibility. Pol. J. Radiol. 2015;80:210-216. 12. Yafour N. et al. Cyclosporine-related brainstem atypical posterior reversible leukoencephalopathy syndrome following hematopoietic stem cell transplant. Hematol. Oncol. Stem. Cell Ther. 2015 Apr 28. 13. Guimaraens L. et al. Transient encephalopathy from angiographic contrast: a rare complication in neurointerventional procedures. Cardiovascular and interventional radiology. 2010 Apr;33(2):383-388. 14. Nagamine Y et al. Contrast-induced encephalopathy after coil embolization of an unruptured internal carotid artery aneurysm. Internal medicine (Tokyo, Japan). 2014;53(18):2133-2138. 15. Merchut M.P. Richie B. Transient visuospatial disorder from angiographic contrast. Archives of neurology. 2002 May;59(5):851-854.
