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  Indian J Med Microbiol
 

Figure 4: A 76-year-old woman with history of diabetes mellitus type 2 and hypertension presented with right hemiparesis for approximately 2 h, with unfavorable outcome after successful mechanical thrombectomy. Axial NCCT brain at ganglionic level (a) and supraganglionic level (b) showed hypodense area at left insular cortex, left lentiform nucleus, left anterior MCA cortex (M1), and superior territory of left lateral MCA (M5); NCCT-ASPECTS was 6 points. CTA brain axial (c) and coronal (d) images showed abrupt filling defect at M1 segment of left MCA (red arrow). CTP brain at ganglionic level (e-h) and supraganglionic level (i-l) showed core infarction at left lentiform nucleus (less than 1/3 of left MCA territory) and mismatch area between CBV (f and j) and MTT (h and l) at left frontotemporoparietal area (CTP-ASPECTS at 50% cut point: CBF-ASPECTS = 1, CBV-ASPECTS = 6, TTP-ASPECTS = 2, MTT-ASPECTS = 2; CTP-ASPECTS at 75% cut point: CBF-ASPECTS = 0, CBV-ASPECTS = 8, TTP-ASPECTS = 2, MTT-ASPECTS = 2). Cerebral angiogram AP view of left ICA pre-IAT (m) showed total occlusion atM1segment of left MCA (red arrow). The same view post-IAT (n) showed recanalization of M1 segment of left MCA. Although TICI 3 was achieved, the patient's mRS score at 3 months was 5 points. NCCT – Noncontrast computed tomography; CTP – Computed tomography perfusion; CTA – Computed tomography angiography; MCA – Middle cerebral artery; TTP – Time to peak; CBF – Cerebral blood flow; IAT – Immunoaugmentative therapy; ASPECTS – Alberta stroke program early computed tomography score; MTT – Mean transit time; AP – Anteroposterior

Figure 4: A 76-year-old woman with history of diabetes mellitus type 2 and hypertension presented with right hemiparesis for approximately 2 h, with unfavorable outcome after successful mechanical thrombectomy. Axial NCCT brain at ganglionic level (a) and supraganglionic level (b) showed hypodense area at left insular cortex, left lentiform nucleus, left anterior MCA cortex (M1), and superior territory of left lateral MCA (M5); NCCT-ASPECTS was 6 points. CTA brain axial (c) and coronal (d) images showed abrupt filling defect at M1 segment of left MCA (red arrow). CTP brain at ganglionic level (e-h) and supraganglionic level (i-l) showed core infarction at left lentiform nucleus (less than 1/3 of left MCA territory) and mismatch area between CBV (f and j) and MTT (h and l) at left frontotemporoparietal area (CTP-ASPECTS at 50% cut point: CBF-ASPECTS = 1, CBV-ASPECTS = 6, TTP-ASPECTS = 2, MTT-ASPECTS = 2; CTP-ASPECTS at 75% cut point: CBF-ASPECTS = 0, CBV-ASPECTS = 8, TTP-ASPECTS = 2, MTT-ASPECTS = 2). Cerebral angiogram AP view of left ICA pre-IAT (m) showed total occlusion atM1segment of left MCA (red arrow). The same view post-IAT (n) showed recanalization of M1 segment of left MCA. Although TICI 3 was achieved, the patient's mRS score at 3 months was 5 points. NCCT – Noncontrast computed tomography; CTP – Computed tomography perfusion; CTA – Computed tomography angiography; MCA – Middle cerebral artery; TTP – Time to peak; CBF – Cerebral blood flow; IAT – Immunoaugmentative therapy; ASPECTS – Alberta stroke program early computed tomography score; MTT – Mean transit time; AP – Anteroposterior