PMC3858203_01
(A) Maximum intensity projection reconstruction of CT-angiography demonstrates left M1 occlusion 130 minutes after symptom onset. (B) Good contrast of left lateral insular branches indicates good collateral flow into the left MCA territory. (C) Initial digital subtraction angiography (DSA) at intervention demonstrates complete left MCA mainstem occlusion. (D) Post-embolectomy DSA shows complete perfusion recovery of left side MCA 210 minutes after symptom onset.
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Furthermore, cCT showed absence of early stroke signs, a dense artery sign at the left MCA which confirmed as complete MCA occlusion of 10mm length by CT-angiography (CTA) with good collateralization into the Sylvian fissure on CTA (Figure 1). Embolectomy using a retractable stent (Solitaire  EV3) resulted in complete and successful recanalization of the MCA and its branches about 210 minutes after symptom onset (Figure 1).
(A) T2-weighted MRI 6 days later demonstrates partial left ACA ischemia and basal ganglia and a homogenous lesion of left MCA territory sparing the subcortical white matter. Note the pronounced vessel of the left MCA territorium. (B) Apparent diffusion maps maps showing partial anterior and complete MCA infarction. (C) Corresponding diffusion weighted imaging. Note the distinct lesion pattern in the partial ACA and basal ganglia infarct compared to the MCA territory. (D) Contrast-enhanced MR angiography demonstrates the pronounced hyperperfusion of the left MCA territory.
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The T2-weighted sequences demonstrated dilated MCA branches indicative for compromised vasoreactivity (Figure 2).