ASPECTS: 10

mCTA: 10:06 am

No proximal branch occlusion identified.

Multiphase CTA demonstrates a region of subtle contrast hold-up in the distal right ACA territory. On further reviewing an occlusion of the A3 segment of the right ACA is identified. 

Decision making:

Patient improved spontaneously after the baseline CT/ CTA.

No IV thrombolysis- elevated INR

No IR- distal occlusion, clinically improved

After 4 hours, patient deteriorates clinically with new onset acute right leg weakness.

Repeat CT/ CTA: No changes in findings

Planned for endovascular thrombectomy. After transferring to angio-suite, patient again improved. It was decided to manage conservatively with close monitoring.

24 hours CT Head:

Small patchy infarcts in the right parasagittal frontal lobe (right ACA territory) without hemorrhagic transformation or significant mass effect.