Extensive intra- and extra-cranial atherosclerotic disease but no large vessel intra-cranial occlusion. There is critical narrowing of the right proximal ICA due to a mixed calcified and non-calcified plaque.
RAPID summary shows a large mismatched defect in the right MCA and posterior circulation without a core making it difficult to know whether this is a chronic compensated state or if there is a superimposed acute insult. MTT is more symmetric but the right side appears to have asymmetrically greater MTT prolongation so this can be taken as perfusion evidence suggestive of a superimposed acute insult. Of course the most definite evidence was from the head CT which pretty clearly showed a likely area of peri-rolandic acute infarction.