PMC8326091_01
(a) Magnetic resonance imaging shows acute infarction in the left frontal lobe with an Alberta stroke program early computed tomography score of 7 on diffusion-weighted imaging. (b) Magnetic resonance angiography shows occlusion of the left internal carotid artery. (c) Computed tomography angiography reveals occlusion of the left common carotid artery origin without aortic dissection.
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F1
Magnetic resonance imaging (MRI) showed acute and subacute infarctions in the left frontal lobe with an Alberta stroke program early computed tomography score (ASPECTS) of 7 on diffusion-weighted imaging (DWI) [Figure 1a]. Magnetic resonance angiography (MRA) showed occlusion of the left ICA to the left middle cerebral artery (MCA) [Figure 1b]. Computed tomography angiography revealed occlusion of the LCCA origin [Figure 1c].
(a) Angiography of the left common carotid artery (LCCA) demonstrates severe stenosis visualization of the LCCA (red arrow) and thrombus (red arrowhead). (b) Angiography of the internal carotid artery (ICA) reveals occlusion of the left ICA terminus with ICA flow stagnation. (c) Reperfusion of the left middle cerebral artery territory is confirmed. (d) Angiography of the LCCA confirms patency of the LCCA origin (red arrow) at the end of endovascular treatment. (e) We placed a double-layered micromesh stent under breath-hold to prevent misalignment. Angiography confirms successful revascularization of the LCCA. (f) Postoperative computed tomography angiography reveals revascularization of the LCCA origin (red arrow) by successful stenting.
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F2
Aichi, Japan) was positioned at the proximal end of the LCCA origin through the right femoral artery under local anesthesia. Angiography of the LCCA revealed severe stenosis of the LCCA and thrombus [Figure 2a]. Second, the OPTIMO was advanced over the JB2 catheter and the Radifocus in the ICA, and angiography of the ICA revealed left ICA terminus occlusion [Figure 2b]. Reperfusion of the left MCA territory was confirmed by contralateral ICA flow through the anterior communicating artery with left ICA flow stagnation [Figure 2c]. As a result, recanalization of the LCCA was achieved without emboli in any new territories [Figure 2d]. Angiography from the LCCA demonstrated successful revascularization of the LCCA [Figure 2e]. Postoperative computed tomography angiography revealed revascularization of the LCCA origin by successful stenting [Figure 2f].
PMC8326091_02
(a) Magnetic resonance imaging (MRI) shows acute infarction in the left frontal lobe with an Alberta stroke program early computed tomography score of 8 on diffusion-weighted imaging. Magnetic resonance angiography (MRA) shows occlusion of the left middle cerebral artery (MCA). (b) MRI shows acute infarction in the left frontal lobe with an Alberta Stroke Program Early Computed Tomography score of 8 on diffusion-weighted imaging. MRA shows occlusion of the left MCA. (c) Angiography of the left common carotid artery (LCCA) demonstrates severe stenosis of the LCCA origin. (d) Angiography of the internal carotid artery reveals left MCA occlusion. (e) Reperfusion of the left MCA territory is confirmed. (f) Angiography confirms successful revascularization of the LCCA by successful stenting.
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F3
MRI/MRA showed acute infarction with a DWI-ASPECTS of 8 and occlusion of the left MCA [Figure 3a and b]. However, angiography of the LCCA revealed severe stenosis at the origin [Figure 3c]. We achieved recanalization of the MCA, but severe stenosis of the LCCA remained [Figure 3d and e]. Because of the tortuous aortic arch, she underwent LCCA stenting using a trans-carotid approach with an mRS score of 1 on day 167 from onset [Figure 3f].