One of these things some people keep waiting to see happen. Not pretty in real life though. Bilateral lower extremity weakness can lead to delay in diagnosis of an intracranial occlusion.
By angio time, the right hemispheric branch has recanalized. Left remains closed.
So, why does an embolus go to the ACA here? Its not chance — the answer is on the image above
More clues below
Sofia is our current choice of aspiration catheter. Pretty nice reach — this one went over an 021 headway. Notice that the Sofia OD is a bit larger than the target vessel ID — access is still possible usually, and clot removal is highly likely
Post CT — bilateral staining attests to late reperfusion and parenchymal injury.
Conclusion — not a great outcome. My first experience with a brain vessel variant was seeing a ruptured pericalossal in med school. Its a disadvantage and i hope never to see another stroke like this again