Endovascular therapies for acute ischaemic stroke represent important alternatives or adjuncts to thrombolysis. A middle‐aged male suffered a Thrombolysis in Myocardial Infarction (TIMI) Grade 0 distal left middle cerebral artery (LMCA) occlusion resulting in right hemiparesis and dysphasia. Intravenous thrombolysis was contraindicated due to pre‐existing anticoagulant therapy and associated risk of intracranial haemorrhage. The patient underwent rescue mechanical embolectomy with an L5 Merci Retriever, with adjuvant local intra‐arterial (IA) thrombolysis. Successful TIMI Grade 3 restoration of LMCA blood flow occurred within eight hours of ictus. Aphasia resolved within 24 hours, whilst other motor and speech symptoms gradually improved over 6 months, allowing the patient to resume work and independent living. Mechanical embolectomy appears to be a safe and effective alternative in cases of delayed presentation, or where intravenous thrombolysis is contraindicated. Combined mechanical embolectomy and adjuvant IA thrombolysis, instituted within eight hours of ictus in an anticoagulated patient, achieved favourable clinical outcome (modified Rankin Score of 2) without major thromboembolic or haemorrhagic complications.

A ruptured gastric artery aneurysm is a rare but important possible cause of massive intra-abdominal or gastrointestinal haemorrhage, and carries a high risk of mortality. Although aneurysms of the gastric arteries are uncommon, emergency radiologists and clinicians should be familiar with the clinical presentation, imaging findings and pathophysiology. We present two cases of massive intra-abdominal haemorrhage and haemodynamic shock secondary to acute rupture of previously occult gastric artery aneurysm and review the relevant anatomy, imaging findings and pathophysiology of gastric and other visceral artery aneurysms. By virtue of its location in the lesser omentum, a ruptured gastric artery aneurysm may result in a typical pattern and distribution of adjacent haematoma in the upper abdomen. Our description of imaging findings highlights a characteristic epicentre of intraperitoneal haemorrhage, and its typical mass effect displacement of surrounding viscera, to aid the emergent diagnosis of gastric artery aneurysm rupture.