FIGURE 1.
(A) DWI MRI b1000 sequence showing hyperintensity in keeping with hyperacute infarct, at the right MCA territory. (B) The corresponding ADC MRI sequence showing hypointensity at the same region, which confirms a hyperacute infarct. (C) The FLAIR sequence showing no signal changes at the affected region, in keeping with evidence of DWI-FLAIR mismatch. (D) The MRA sequence shows truncation of the proximal right MCA vessel, in keeping with MCA occlusion/large vessel occlusion (white circle). ADC, apparent diffusion coefficient; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; MCA, middle cerebral artery; MRI, magnetic resonance imaging.
FIGURE 2.
(A) Preliminary angiogram (prior to EVT) showing evidence of proximal right MCA occlusion (white arrow). (B) Preliminary angiogram in lateral view, demonstrating the right MCA occlusion. (C) Post-ADAPT/aspiration thrombectomy single pass shows evidence of critical stenosis (white arrow). Delayed contrast filling/perfusion is also noted (white arrows) distal to this critical stenosis. (D) DEB catheter is seen on this angiogram (roadmap) crossing the lesion/critical stenosis, aided by microwire. ADAPT, a direct aspiration first-pass technique; DEB, drug-eluting balloon; EVT, endovascular thrombectomy; MCA, middle cerebral artery.
FIGURE 3.
(A) Post-DEB angioplasty angiographic run shows restoration of perfusion distal to the critical stenosis, with no delay compared to the unaffected territory (TICI 2 C/3 revascularization). (B) Post-DEB angioplasty lateral view angiography, showing no perfusion defects. DEB: drug-eluting balloon.
FIGURE 4.
Surveillance MRA showing patency of the previously occluded right MCA vessel, which displays a similar signal compared to the contralateral, unaffected MCA vessel. MCA, middle cerebral artery.