Carotid T Occlusion CTA

Clinical History: 72 year old female ( From Afghan moved to Canada 1 yr back) with acute onset left hemiparesis and speech disturbance. Presented to ER in an hour. NIHSS 15 ish. 

NCCT: 8:54 pm ASPECTS- 8 ish ( probable insula, M5 involvement). Hyperdense MCA sign, best seen on thick MIPs.

CTA: "T" occlusion, involving long segment of terminal ICA, M1 and A1. Origin of anterior choroidal involved, with some forward flow.

         Collaterals: Very good collaterals despite T occlusion. Delayed washout seen.

         Arch anatomy: Difficult

IR: Puncture time: 21:55 pm

     Difficult groin puncture complicated by flow limiting dissection. Left groin punctured. 4x 40 mm Solitaire stent used to retrieve clot. One pass. Final TICI 2c/3. 

24 hr Follow up MR:  ASPECTS: 8 ish. Basal ganglia infarcts with hemorrhage/ contrast staining.

Clinical f/u: Improved, NIHSS 3

T appearance standard column of blood. Ghosting. Right