Its not all about the big branches. Outcome is determined to large extent by status of the Anterior Choroidal and lesser extent the lenticulostriates.

As one can see from immediate post thrombectomy images below, the cortex is spared. Even the insula is spared. Yet the patient keeps profound deficits.

Later CT

There is no pre-thrombectomy perfusion. but from these images alone one can tell where the occlusion was and what arteries have been occluded and what territory has no good collaterals. Can you recognize the POSTERIOR choroidals? Which POSTERIOR choroidal is not seen? Why?

Post thrombectomy

Detail

There is no DYNA — so you have to figure out the anterior-posterior choroidal relationships here. The outcome of course is on CT

BONUS — what other territory, typically not part of the MCA, is infarcted here, and why?

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