Fig. 2

An 80-year-old female patient arrived at the hospital 1.5 h after the onset of symptoms, with a baseline NIHSS score of 20. The NCCT-, Auto- and CTP-ASPECTS were 10, 9, and 8 points (a–c), respectively. CT perfusion showed an infarct core of 5 ml, hypoperfusion of 101 ml, mismatch volume of 96 ml, and mismatch ratio of 20.2 (d). The Auto-ASPECT showed ischemia in the M1 region, while the CTP-ASPECT showed ischemia in the internal capsule and the lentiform nucleus region. The maximum intensity projection showed that the proximal M1 segment of the middle cerebral artery was occluded (e). The infarct core shown by CT perfusion was equivalent to the final infarct volume shown by NCCT reviewed 16 h after successful mechanical thrombectomy (f). The patient had a good 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