Distal occlusion, use of mCTA

mCTA: No proximal artery occlusion on single phase CTA.

Collaterals: Good

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.

Arch anatomy: Type 2 arch

CT perfusion: Small area of potential infarct- on TMax map in left inferior frontal gyrus

3] Decision making: IV tPA- Yes 

4] 24 hr MRI- Small infract in the left MCA territory, no hemorrhage