Fig. 1

A 75-year-old male patient was sent to the emergency department 8 h after the onset of symptoms with a baseline NIHSS score of 22. The NCCT-, Auto- and CTP-ASPECTS were 4, 4, and 2 points (a–c), respectively. CT perfusion revealed an infarct core of 50 ml, hypoperfusion of 151 ml, mismatch volume of 101 ml, and mismatch ratio of 3.0 (d). The maximum intensity projection showed that the proximal M1 segment of the right middle cerebral artery was occluded (e). The patient successfully underwent mechanical thrombectomy 65 min after admission. A review of the NCCT 14 h after revascularization revealed a large infarction of the right temporal lobe with intracranial hemorrhage (f). The patient had a poor clinical outcome at the 90-day follow-up. * indicates the regions of the early ischemic changes of the 10 defined middle cerebral artery (MCA) vascular territories. C = caudate head, I = insula, IC = internal capsule, L = lentiform nucleus, M1 = frontal operculum, M2 = anterior temporal lobe, M3 = posterior temporal lobe, M4 = anterior MCA, M5 = lateral MCA, M6 = posterior MCA