44 year old male with acute onset speech difficulty. LSN 2 hours. NIHSS5

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.

Collaterals: Good

Arch anatomy: Type 2 arch