Left MCA occlusion - thrombectomy

Case contributed by Dr Francis Fortin

Presentation

Signs of acute stroke in the left Sylvian territory.

Patient Data

Age: 65 years
Gender: Female

Non-contrast CT shows lower density with subtle loss of gray-white matter differentiation along the left insular ribbon (loss of the insular ribbon sign) and temporal operculum, signs of early ischemic change. There is spontaneously increased density in the M1 segment of the left middle cerebral artery (MCA), consistent with acute thromboembolic occlusion (hyperdense MCA sign).

CT angiogram (brain CTA) shows abrupt cutoff of contrast at M1 segment of left MCA.

Maximum intensity projection images better show the occlusion because of thicker slices.

3D reconstruction from the CTA demonstrates the abrupt cutoff of contrast in the M1 segment of the left MCA.

Digital subtraction angiography shows an abrupt cutoff of contrast in the M1 segment of the left MCA.

Mechanical thrombectomy was performed with a Solitaire™ stent retriever with subsequent optimal restoration of flow within the previously-occluded left MCA.

Annotated images describing the findings outlined above.

Case Discussion

An annotated case of a patient admitted for suspected stroke in the left Sylvian/MCA territory with a stroke-protocol CTA demonstrating signs of acute thromboembolic infarction in the distribution of the M1 segment of the left MCA. Mechanical thrombectomy allowed for adequate reperfusion and improvement of clinical symptoms.

**This case is part of the teaching curriculum for the neurology module during MD training at Université de Montréal.**

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