Fig. 3
From: An historical and contemporary review of endovascular therapy for acute ischemic stroke
Illustrative cases of difficult patients pushing boundaries of conventional therapeutic criteria: Poor collaterals but early time to presentation and treatment. Forty-two year old male with witnessed collapse at 19:20. Presents ultra-early, 35 min post collapse, with left MCA syndrome including right sided weakness, forced gaze deviation and mutism with NIHSS 22. Unfavorable imaging including ASPECTS 5 (a), hyperdense left MCA vessel, left M1 (CTA b), left proximal A2 (not shown) occlusions with poor collaterals and matched CT perfusion defect (CBV, MTT c, d). Patient was treated with IVT (DTN time 37 min; OTT time 72 min) and EVT (DSA (e) with successful recanalization 141 min post stroke onset). No tPA/EVT complications but no neurological improvement with a 24 h NIHSS of 23. Patient developed malignant infarction requiring decompressive hemicraniectomy. Day 90 mRS 2