MCA stroke

Case contributed by Prof Peter Mitchell

Presentation

Right hemiparesis, facial droop, heart valve. Not on anticoagulation.

Patient Data

Age: 75 years
Gender: Male
CT

CT CTA

No acute changes. HMCAS/ICA terminus. Failed CTP at initiating hospital. CTA apparent occlusion ICA origin up to ACA/MCA.
DSA (angiography)

DSA

Stagnant contrast into ICA bulb can still represent distal occlusion. First pass retrieved thrombus from ICA "T" but too tortuous to reach distal MCA clot. Second pass with distal access catheter and suction TICI 3.
MRI

MRI

Complete recovery. Minor infarction as documented.

Case Discussion

CTA commonly overcalls ICA occlusion proximal extent - in this case distal ICA at initial imaging. First DSA showed had progressed to ICA T and M1. Two passes and recanalisation 6 hours post onset, 75 minutes post on table.

mRS = 0

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Case information

rID: 47070
Case created: 30th Jul 2016
Last edited: 22nd Mar 2017
Inclusion in quiz mode: Included

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