Left MCA stroke for ECR - tortuous access

Case contributed by Prof Peter Mitchell


Hemiplegia, aphasia.

Patient Data

Age: 85 years
Gender: Male

Left MCA M1 MID occlusion.  Note tortuous left CCA and arch. Large penumbra on perfusion. 


DSA (angiography)

Patient limited ability to cooperate hence early decision for GA based in part on imaging.

BGC. Single pass Trevo 4*30. TICI 2b recanalization. 

Case Discussion

Identifying the intracranial anatomy and occlusion, assessing for the presence of hemorrhage, hyperdense artery, early signs of infarction, core infarct on CTP are becoming standard imaging and performed well.  The extracranial circulation also needs assessment to identify factors that may influence treatment decisions or planning.

Tandem occlusions, arterial dissections, additional pathology such as intracranial aneurysms, and anatomy of the access vessels (including congenital variations & tortuousity of both the aortic arch and great vessels) are important.  

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Case information

rID: 45667
Published: 5th Jun 2016
Last edited: 20th Aug 2019
Inclusion in quiz mode: Included

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