PMC5712569_01
(A) DWI sequence showing a hyperintensity (arrow: infarct) in the right insula. (B) Perfusion imaging demonstrating increased mean transit time in the right middle cerebral artery (MCA) territory. (C) Magnetic resonance imaging with diffusion and perfusion-weighted sequences processed using Olea Sphere (Olea Medical Solutions, Inc., Cambridge, MA, USA) demonstrates volume of core infarct in red and hypoperfusion in blue, consistent with a large area of ischemic penumbra in the right MCA distribution.
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ABC/2 method. A large area of perfusion deficit, coupled with small area of infarction, is what is commonly referred to as a large perfusion/diffusion mismatch (Figure 1).
(A) Right middle cerebral artery (MCA) cutoff (M1) in a computed tomography angiogram (linear arrow). (B) Digital subtraction angiography (antero-posterior) exhibiting a recanalization of the right MCA post-thrombectomy. The long arrow identifies the thromboembolic occlusion of a distal right anterior cerebral artery segment. (C) Long-axis echocardiogram demonstrating biatrial enlargement. (D) Cardiac magnetic resonance imaging re-demonstrating the biatrial enlargement, and also revealing a small pericardial effusion (short arrow).
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Raynham, MA, USA) was navigated into the distal cervical right internal carotid artery (ICA). Right ICA injections showed a right M1 segment MCA occlusion just distal to the origin of the right anterior temporal artery (Figures 2A,B). Trevo were performed while under continuous aspiration through the base catheter during retraction of the retrievable stent. Thrombolysis in cerebral infarction (TICI) 3 right MCA recanalization was achieved within 1.5 h of completion of the MRI, for a total time between symptom onset to recanalization of 8.5 h. This procedure was complicated by thromboembolic occlusion of the A2 segment of the right anterior cerebral artery (Figure 2). An urgent transesophageal echocardiogram confirmed bilateral severe atrial enlargement with normal ventricular size and function, with cardiac MRI confirming the diagnosis of restrictive cardiomyopathy and the absence of an intracardiac thrombus (Figure 2).