Distal occlusion, use of mCTA
44 year old male with acute onset speech difficulty.
LastSeenNormal (LSN) 2 hours. NIHSS<5
Baseline imaging: NCCT – 09:02 am
mCTA: No proximal artery occlusion on single phase CTA.
Multiphase CTA: shows a patchy area of contrast hold-up involving the left frontal lobe (middle and inferior frontal gyri posteriorly). Retrospectively an M4 branch occlusion is identified.
Arch anatomy: Type 2 arch
CT perfusion: Small area of potential infarct- on TMax map in left inferior frontal gyrus
3] Decision making: IV tPA- Yes
4] 24 hr MRI- Small infract in the left MCA territory, no hemorrhage