PMC2875360_01
Noncontrast CT pre- (A) and post- (B) intravenous thrombolysis reveals persistent left MCA hyperdensity.
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F1
Noncontrast CT revealed left middle cerebral artery (MCA) hyperdensity (Fig 1 A). Scanner malfunction limited MRI acquisition, yet non-contrast CT showed persistent left MCA hyperdensity (Fig 1 B).
MRI/MRA after neurological deterioration demonstrates left MCA thrombus on gradient-echo images (A) and lack of antegrade flow on MRA (B). Subcortical ischemia in the lenticulostriate distribution on diffusion (C), with a larger extent of hypoperfusion on time-to-peak maps (D).
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F2
Emergent MRI/MRA revealed no hemorrhage, but persistent left MCA occlusion with extensive diffusion-perfusion mismatch (Fig 2).
Angiography demonstrates left MCA occlusion with retrograde leptomeningeal collateral filling (A). Clot retrieval with the Merci  device (B) results in M1 recanalization (C) at almost 14 hours.
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F3
Immediate angiography demonstrated proximal left MCA occlusion with extensive retrograde leptomeningeal collateral perfusion (Fig 3 A). On second pass of the Merci  device (Fig 3 B), a 1.0 x 1.0 mm thrombus was withdrawn. Postthrombectomy angiography revealed M1 recanalization (Fig 3 C).
Postprocedural MRI 3 hours later reveals prior lenticulostriate infarction (A) with limited hypoperfusion in left inferior frontal region (B) corresponding to branch occlusion on angiography.
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F4
Immediate resolution of hemiparesis with residual nonfluent aphasia corresponded to restricted inferior frontal hypoperfusion on postprocedural MRI at 3 hours (Fig 4 B).
Day 7 MRI demonstrates scattered diffusion lesions (A) without residual hypoperfusion (B).
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F5
Day 7 MRI revealed scattered diffusion lesions without hypoperfusion (Fig 5).