Figure 1.

Illustrative images of a large vessel occlusion (LVO) stroke patient. Patient was a 67-year-old male presenting 4 h after onset with a full right middle cerebral artery (MCA) syndrome due to right MCA occlusion, NIHSS 14. (A) Emergent head computerized tomography without hemorrhage as a cause of stroke syndrome. (B) Axial maximal intensity projections from CTA showing right MCA occlusion (white arrow). (C) Emergent MRI DWI showing a small established core infarct. On the basis of this combined imaging and clinical data, it was determined that the patient had a large penumbra and small region of established injury and was therefore a good candidate for reperfusion therapy. (D) Anteroposterior view, catheter angiogram. The right internal carotid artery (ICA) injection reveals thrombus at the carotid terminus with only minimal anterior cerebral artery (ACA) opacification seen. Findings are consistent with an ICA-T occlusion. (E) Complete recanalization following mechanical thrombectomy, with full reperfusion (not shown) of the threatened penumbra. (F) 24 h MRI DWI showing arrest of infarct growth following reperfusion of the penumbra. The patient improved to NIHSS 4 by discharge on day 3 post-op. His stroke was determined to be cardioembolic following detection of atrial fibrillation after complete evaluation for cause, and he was free of deficits at 90-day follow-up.