Right ACA Occlusion on mCTA

77 year old female presented with acute left leg weakness. On Warfarin for a known Atrial fibrillation, elevated INR. LSN 3 hours. NIHSS <6

Baseline imaging: NCCT- 10:04 am

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.