MRA examination showed that the intracranial segment of the left internal carotid artery (yellow arrow) and the distal segment of the right distal carotid artery were markedly thin. In addition, A1 segment of bilateral cerebral anterior (white arrow) was not found, and A2 segment was markedly thin. A near-complete occlusion was found in the M1 segment of the right middle cerebral artery (red arrow) with sparse distal branches. The left posterior cerebral artery (blue arrow) was also thin, with sparse distal branches. Compensatory multiple small “puffy smoke like” vessels were found in the saddle area, the Cisterna ambiens, and the parietal lobe near the middle line (black arrow).