86 yo Patient with Poor ASPECTS, EVT, Good Outcome
86 year old male presenting with acute left sided weakness and facial droop, 3 hours from onset. NIHSS >15. Known A-fib on epixaban. Independent, living in home.
Baseline imaging: NCCT: 09:00 am
ASPECTS: Caudate, lentiform nucleus, insula, M1, M2, M3 involved; ASPECTS score: 4
mCTA: 09:02 am Target occlusion:
Right cervical ICA and M1- tandem occlusions
Large Thrombus with the right ICA.
CT Perfusion: 09:06 am- Large penumbra with small infarct core (CBV vs TMax)
Increased MTT and relatively normal CBV. Equates to a Large penumbra.
Fair, with good extent and delayed washout. Arch anatomy: Type II arch, moderately difficult arch.