Figure 1.

A-F) Mechanical thrombectomy in acute stroke pre and post-procedure DSA. Selective left-ICA images showing complete occlusion of left-MCA / M1 division at its origin (arrow) (A). Merci 2.5 V series deployed via the Microcatheter using triaxial system (Neuron Guide, DAC and the Microcatheter from proximal to distal, arrows) (B). Post Merci left ICA run showing improvement in the cerebral flow, with residual clot at the M1, A1 and Inferior MCA division (arrows) (C). The Penumbra device was then used via the DAC with significant improvement but persistent M2 inferior division clot (arrow) (D). Gateway balloon deployed in MCA inferior division to disrupt the clot (E), with final left ICA angiogram showing complete revascularization of the Left MCA artery (F); Abbreviations: DSA; digital subtraction angiography. ICA; internal carotid artery. MCA; middle cerebral artery. DAC; distal access catheter.