LAUSR

BACKGROUND and Importance: Bilateral hemispheric dysfunction is devastating to consciousness. We present a unique case of a patient who developed bilateral MCA infarcts with significant neurological improvement post bilateral TICI 3 thrombectomies. CLINICAL PRESENTATION The patient is a 64-year-old female who presented 3 hours after her husband was awoken and found her with left hemiplegia. She had a history of atrial fibrillation and had her apixaban held for five days before the coronary angiogram that she received the day before arrival. Upon presentation, she was antigravity on the right side and withdrawing on the left side. CTA showed a right M1 occlusion and an left M2 occlusion. CTP revealed a mismatch with large penumbra, and she was taken for mechanical thrombectomy. Mechanical thrombectomy was performed using a combination of stent retriever and aspiration catheter with a TICI 3 revascularization. By the following morning, the patient was full strength on the right and antigravity on the left with a left facial droop. The patient recovered her speech and was fully oriented before leaving for rehab on postoperative day 3. CONCLUSION The transient hypercoagulable state that was created with the withdrawal of apixaban likely increased our patient's risk of stroke. The literature supports continuing oral anticoagulants for endovascular procedures. The devasting consequences of thromboembolic events, whether stroke or pulmonary embolism can be catastrophic, but luckily, mechanical thrombectomy provides the means to minimize the morbidity and mortality from bilateral infarctions.