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86 yo Patient with Poor ASPECTS, EVT, Good Outcome

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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.