Presentation
Right hemiplegia.
Patient Data
Post intravenous thrombolysis in the mobile stroke unit. Occluded left carotid T and M1 artery with an established small infarction and large ischemic penumbra.
Angiography shows a supraclinoid ICA occlusion.
A triaxial system (Neuron Max, Sofia 6+ and Velocity microcatheter) was used. Two passes using a 4 mm x 25 mm Trevo device (plug and pull) produced good revascularization. No angiographic complications.
Subtle loss of grey-white matter differentiation at the insular cortex is compatible with established infarct. Mild left convexity sulcal effacement suggestive of cerebral edema. No evidence of hemorrhagic transformation. No acute intracranial hemorrhage is seen elsewhere.
A moderate to large left MCA territory infarct including the left head of caudate nucleus and left lentiform nucleus. No additional territorial infarct.
Case Discussion
Despite early intravenous thrombolysis and endovascular clot retrieval, a substantial MCA infarct is present, predicted by perfusion core.
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