Fig. 1

Radiological imaging of the patient. A non-contrast CT scan of the head revealed a right hyperdense middle cerebral artery sign (average 138 HU, white arrow), with already infarction in the basal ganglia (not shown) in the right hemisphere but no signs of intracranial hemorrhage (a). On DSA, initial runs confirmed a complete occlusion of the distal M1-segment of the right middle cerebral artery (black arrow) with good pial collateralization (b). Final angiographic result after the 11th thrombectomy attempt showing a complete recanalization of the right middle cerebral artery (c, black arrow). The thrombus appeared hard and white macroscopically (d). DWI-MRI demonstrated restricted diffusion in the right basal ganglia and several smaller cortical and subcortical lesions 24 h after the endovascular treatment (e, white arrows) and MRA showed recanalization of the previously occluded segment of the right middle cerebral artery (f, white arrow)