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case_images: (A) Baseline axial CT performed 360 min after the symptom onset showing a faint hypodensity in the left frontotemporoparietal lobe with a RAPID-ASPECTS of score 1. (B) CTA showed a complete occlusion of the left M1. (C) The RAPID-CTP analysis demonstrated a complete infarct volume of 76 milliliters (mL), entailing a small infarcted core within a large volume of penumbra in the right internal carotid artery vascular territory. The configured Tmax > 6-second volume representing the combination of the infarcted core volume and hypoperfused brain was 143 mL in the left cerebral hemisphere, deriving a mismatch ratio of 1.9.
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case_images: There was no definite ischemic change or hemorrhage (Figure 1A). CT angiography (CTA) showed complete occlusion of the left proximal M1 (Figure 1B). Computed tomography perfusion (CTP), RAPID map (IschemaView), showing a perfusion deficit (Tmax > 6 seconds) 143 mL and ischemic core (CBF < 30%) of 76 mL at left MCA territory (Figure 1C).
case_images: (A) Digital subtraction angiography (DSA), left internal carotid artery injection, anteroposterior (AP) view, showing proximal left middle cerebral artery (MCA) M1 occlusion with intraluminal filling defect due to thrombosis. (B) DSA, AP view, showing a 4-mm x 40-mm Solitaire X (Medtronic) stent-retriever (SR) un-sheathed in the affected MCA with reopening of the vessel. (C) DSA, AP view, post-thrombectomy, showing successful recanalization and restoration of blood flow.
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case_images: Digital subtraction angiography (DSA) with left internal carotid artery (ICA) injection revealed left proximal M1 thrombosis (Figure 2A). Stent-retriever (SR) thrombectomy was subsequently performed by placement of a 4 mm x 40 mm Solitaire X (Medtronic) stent across the thrombus (Figure 2B). After intrathrombus deployment of the SR two times, near-complete recanalization (by the thrombolysis in cerebral infarction (TICI) classification 2b) was achieved (Figure 2C).
case_images: (A) Photograph showing a reddish brown gelatinous thrombus extracted by the stent-retriever. Panels B and C. Photomicrographs of the retrieved thrombi, Hematoxylin and eosin stain, x 100 (B) and x 400 (C), showing fibrin and blood admixed with metastatic adenocarcinoma, which is composed of tubular or fused glands, with pseudostratified epithelium, consistent with colorectal origin. Immunohistochemical stains showed CK7-negative, CD20-positive, and CDX-2-positive.
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case_images: Large amounts of reddish-brown thrombus were found in the SR (Figure 3A). Pathological examination of the retrieved thrombus revealed metastatic adenocarcinoma of rectal origin (Figure 3B and C).
case_images: (A) Contrast-enhanced axial CT and (B) PET/CT fusion images of the thorax showing a left lung mass invading the left atrium and pulmonary vein.
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case_images: On a contrast-enhanced CT and a PET/CT of the chest, a mass in the left hilar region was revealed, infiltrating the pulmonary vein and left atrium (Figure 4A and B).