PMC10159319_01
Head computed tomography scan without contrast revealed hyperdense right middle cerebral artery sign (yellow arrow).
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F1
A head NCCT revealed a hyperdense right middle cerebral artery (MCA) sign, suggesting a hyperacute thrombotic stroke [Figure 1].
(a) Pre-thrombectomy angiogram showed occlusion of the right middle cerebral artery (white arrow) with no collateral flows and (b) post-thrombectomy angiogram showed successful recanalization (white arrow).
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F2
An angiogram of the right internal carotid artery at hour 6 confirmed occlusion of the M1 branch of the right MCA with no collaterals in the territory of the occluded vessel [Figure 2a]. The first attempt of manual aspiration thrombectomy successfully achieved modified thrombolysis in cerebral infarction 3 revascularization in 6 h 20 min [Figure 2b].
The occlusive thrombus.
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F3
The occlusive thrombus [Figure 3] was all removed using the direct aspiration first pass technique with a catheter aspiration system.
(a) Follow-up head computed tomography scan revealed malignant brain edema with significant midline shift on the right hemisphere and (b) the midline shift reduced after decompressive craniectomy.
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F4
Follow-up NCCT [Figure 4a] within 24 h following thrombectomy revealed petechial hemorrhage on the infarcted area and massive focal brain edema on the right frontotemporoparietal, resulting in a 13-mm midline shift (MLS). Follow-up NCCT was performed 4 days after DC [Figure 4b] and revealed decreased mass effect to 6 mm MLS.
Plain chest X-ray showed permanent pacemaker.
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F5
TPM was changed into permanent pace maker after 7 days of its insertion [Figure 5].