Right ACA M3 mCTA Occlusion - 77 year old female presented with acute left leg weakness.

77 year old female presented with acute left leg weakness. On Warfarin for a known Atrial fibrillation, elevated INR. LSN 3 hours. NIHSS <6

2] Baseline imaging:
NCCT- 10:04 am
ASPECTS: 10
mCTA: 10:06 am:
No proximal branch occlusion identified.
Multiphase CTA demonstrates a region of subtle contrast hold-up in the distal right ACA territory. On further reviewing an occlusion of the A3 segment of the right ACA is identified.

3] Decision making:
Patient improved spontaneously after the baseline CT/ CTA.
No IV thrombolysis- elevated INR
No IR- distal occlusion, clinically improved
After 4 hours, patient deteriorates clinically with new onset acute right leg weakness.
Repeat CT/ CTA: No changes in findings
Planned for endovascular thrombectomy. After transferring to angio-suite, patient again improved. It was decided to manage conservatively with close monitoring.

4] 24 hours CT Head:
Small patchy infarcts in the right parasagittal frontal lobe (right ACA territory) without hemorrhagic transformation or significant mass effect.

Accession: CL0256

Study description: CT HEAD AND NECK ANGIOGRAM=HD