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Distal occlusion, use of mCTA

44 year old male with acute onset speech difficulty.

LastSeenNormal (LSN) 2 hours. NIHSS<5 

Baseline imaging: NCCT – 09:02 am


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

Screen Shot 2017 10 10 at 9.01.49 PM

3] Decision making: IV tPA- Yes 

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