Right MCA M1 occlusion

Case contributed by Dr Bruno Di Muzio


Left hemiparesis.

Patient Data

Age: 71
Gender: Male

CT Brain + CTA

Non-contrast CT showing hyperdense M1 segment of right MCA which confirms to be a thrombotic occlusion on further CTA study. There is no abnormal parenchymal attenuation.  


MRI Brain (stroke protocol)


DWI/ADC sequence only was obtained as per Quick DWI protocol.

No previous cross-sectional imaging for comparison.

Findings: Diffusion restriction involving the entire right caudate nucleus and right lentiform nucleus, cortex of the anterior right temporal lobe and right parietal lobe. Appearance in keeping with extensive acute infarction in the right middle cerebral artery territory.

DSA (angiography)

DSA (Angiography): diagnostic cerebral angiography and clot retrieval


The RIGHT ICA injection showed RIGHT MCA M1 occlusion.

An 8 F balloon guide catheter was placed in the RIGHT ICA proximal segment.

Rebar microcatheter was placed in the RIGHT MCA M2 segment. Microinjection confirmed position of microcatheter.

Single pass with Solitaire 4mm x 20mm stentriever achieved TICI 3 reperfusion.

There were no angiographic complications.

Patient demonstrated on-table improvement of neurological deficits.

Case Discussion

This case illustrates the classical hyperdense MCA sign which corresponds to an increased attenuation of the proximal portion of the MCA related to its thrombosis. 

Middle cerebral artery territory infarcts are the most common due to the size of the territory and the direct flow from internal carotid artery into the middle cerebral artery, providing the easiest path for thromboembolism. 

This patient was promptly identified and evaluated with CTA and MRI being eligible to a clot retrieval endovascular treatment. 

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Case information

rID: 38608
Published: 28th Jul 2015
Last edited: 14th Aug 2019
Tag: rmh
Inclusion in quiz mode: Included

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