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. 2016 Feb 16;1(1):16–22. doi: 10.1136/svn-2015-000004

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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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A 92-year-old man presented with left hemiparesis, dysarthria, hemianopia and inattention National Institutes of Health Stroke Scale (NIHSS) 19. (A) Minimal non-contrast CT ischaemic changes with CT perfusion demonstrating (B) large Tmax lesion in the right middle cerebral artery (MCA) territory and (C) preserved cerebral blood volume indicating minimal irreversibly injured ischaemic core, that is, excellent collaterals and a large ischaemic penumbra. (D) CT angiography revealed a distal M1 MCA occlusion. The patient was treated with intravenous alteplase 80 min post-onset. (E) Partial recanalisation was observed at initial angiogram and he proceeded to Solitaire endovascular thrombectomy; (F) successful revascularisation (mTICI 3) at 2 h post-onset. NIHSS 3 at 24 h with (G) minimal diffusion lesion on MRI. The patient was discharged to rehabilitation on day 5.