Introduction Bilateral internal carotid artery (ICA) occlusion is a rare and life‐threatening cause of acute ischemic stroke, associated with poor outcomes despite advances in mechanical thrombectomy (MT). Here, we present a case of bilateral ICA occlusion successfully treated with MT and provide a review of the existing literature on similar cases. Methods An 80‐year‐old male with a history of hypertension, pulmonary embolism, and cholangiocarcinoma initially presented to an outside hospital with generalized weakness, had sudden decline is mental status on hospital day two and was found to have bilateral ICA occlusion. The patient was transferred to our tertiary care center and underwent bilateral MT with successful Thrombolysis in Cerebral Infarction (TICI) 3 recanalization score after one pass for each occlusion. However, within 24 hours, the patient developed malignant cerebral edema and uncal herniation, leading to death. In addition to this case, we conducted a literature review of previously reported cases of bilateral ICA occlusions treated with MT to contextualize techniques, recanalization, and outcomes. Results Despite technical success in bilateral MT, the patient's rapid deterioration highlights the challenges of managing bilateral ICA occlusions. Review of the literature suggests that, while MT is feasible, the prognosis remains poor, with most patients experiencing significant disability or death. Factors such as age, comorbidities, and timing of intervention play critical roles in determining outcomes. Our findings align with previous reports summarized in Table 1, which underscores both the procedural feasibility and the significant variability in outcomes following MT for bilateral ICA occlusion. Conclusion This case underscores the importance of early intervention for bilateral ICA occlusions, but also emphasizes the high risk of complications such as malignant cerebral edema. Future studies are needed to better define the role of MT in these patients and to identify factors that can predict favorable outcomes. image image
Mehta et al. (Sat,) studied this question.
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