CTA shows no intracranial occlusion or stenosis. There is calcified and noncalcified plaque at the right cervical ICA resulting in severe stenosis.

There’s a large TMAX deficit in the right MCA/ACA and MCA/PCA borderzone without a calculated infarct core (you can see a matched defect on the left corresponding to old infarct). Given the above high grade right carotid stenosis, we can compare MTT to TMAX to see if we’re dealing with a compensated delayed transit or an acute on chronic insult. While the MTT is much more normal than TMAX, there are a few regions where there is also an MTT deficit (red and blue arrows) consistent with acute on chronic hemodynamic compromise.