# Concurrent Middle Cerebral Artery and Basilar Artery Occlusions Treated With Mechanical Thrombectomy in a Patient With Active COVID-19 Infection

## TL;DR

A patient with active COVID-19 developed a rare stroke from two major artery blockages and underwent successful mechanical clot removal, but had poor clinical outcomes.

## Contribution

This case highlights a rare stroke syndrome in active COVID-19 infection with concurrent large vessel occlusions and rapid infarct progression.

## Key findings

- Concurrent basilar and middle cerebral artery occlusions were successfully treated with mechanical thrombectomy.
- Despite successful revascularization, the patient had poor clinical improvement and full MCA territorial infarct.
- The case illustrates a severe cerebrovascular complication of active COVID-19 infection.

## Abstract

We report a rare case of acute ischemic stroke from concurrent large vessel occlusions (LVOs) and subsequent successful mechanical thrombectomy revascularization in a patient with active coronavirus disease 2019 (COVID-19) pneumonia. A 59-year-old woman presented to the emergency department after one week of intermittent chest pain, dyspnea, and diarrhea found to have COVID-19 pneumonia. On hospital day three, the patient developed acute altered mental status and hemiparesis with a National Institutes of Health Stroke Scale (NIHSS) of 22. CT with angiography demonstrated concurrent occlusions of the basilar artery and the M1 segment of the right middle cerebral artery (MCA) without intracranial hemorrhage. The patient was taken for urgent mechanical thrombectomy of the basilar artery, followed by the MCA, both of which were successful (thrombolysis in cerebral infarction (TICI) 3 and 2B) and timely. Despite early revascularization, the patient did not improve clinically with absent brainstem reflexes and a full MCA territorial infarct on imaging. This case describes a rare stroke syndrome of concurrent LVOs with rapid infarct progression despite timely revascularization. This example illustrates a severe cerebrovascular complication of active COVID-19 infection and the importance of vigilance regarding stroke prevention and neurological examination monitoring.