Reversed-Image Mechanical Thrombectomy for Acute Ischemic Stroke in a Situs Inversus Totalis Patient

An 85-year-old female with situs inversus totalis presented with right hemiplegia, right facial nerve palsy, eye deviation to the left, and aphasia. Magnetic resonance imaging revealed acute ischemic lesions in the left insular cortex and the frontal lobe. Magnetic resonance angiography revealed an occlusion of the left internal carotid artery. Reversed-image mechanical thrombectomy achieved complete reperfusion in three passes within 54 minutes. Six months post-intervention, the patient could walk indoors independently. Our technique, which replicates the normal arterial anatomy by inversion and angulation, was adapted to situs inversus totalis.