PMC4093772_01
Case 1. (a, b) Preoperative MR angiography and DWI demonstrating right M1 occlusion and cerebral infarction affecting only part of precentral and central artery territories. (c) Preoperative SPECT showing reduction of the cerebral blood flow in the whole MCA territory. (d) Intraoperative photograph showing an embolus being extracted; (arrowhead) the arteriotomy site and embolus. (e, f) Postoperative MR angiography and DWI demonstrating complete recanalization and no additional cerebral infarction
SNI-5-93-g001.jpg
PMC4093772_01_SNI-5-93-g001.jpg
F1
Magnetic resonance (MR) angiography demonstrated occlusion of the right horizontal segment of MCA (M1) [Figure 1a], but the ischemic lesion was found to affect only part of precentral and central artery territories on diffusion-weighted imaging (DWI) [Figure 1b]. Single-photon emission computed tomography (SPECT) demonstrated reduction of the cerebral blood flow in the whole MCA territory [Figure 1c]. Transverse arteriotomy of the proximal M2 was performed just distal to the MCA bifurcation and the embolus was removed [Figure 1d]. Recanalization was confirmed by MR angiography [Figure 1e], and DWI did not show any new ischemic lesion [Figure 1f] and hemorrhagic lesions.
PMC4093772_02
Case 2. (a, b) Preoperative MR angiography and DWI demonstrating right M1 occlusion and cerebral infarction that extended from the basal ganglia to the corona radiata. (c) Preoperative MR perfusion image showing reduction of the cerebral blood flow in the whole MCA territory. (d) Intraoperative photograph showing an embolus being extracted; (arrowhead) the arteriotomy site and embolus. (e, f) Postoperative MR angiography and DWI demonstrating complete recanalization and no additional cerebral infarction
SNI-5-93-g002.jpg
PMC4093772_02_SNI-5-93-g002.jpg
F2
MR angiography demonstrated right distal M1 occlusion [Figure 2a]. DWI showed an acute ischemic lesion that extended from the basal ganglia to the corona radiata [Figure 2b] and cerebral perfusion was decreased in the whole MCA territory [Figure 2c]. Case 1 [Figure 2d]. Complete recanalization was achieved at 8 h after onset and at 50 min after the start of surgery. Recanalization was confirmed by MR angiography [Figure 2e] and there were no additional ischemic lesions on DWI [Figure 2f] and hemorrhagic lesions.