PMC8053467_01
Preoperative image. (a) Cervical three-dimensional computed tomography angiography: stenosis of the right carotid artery occurred from C4/5 to C5/6, and the stenosis rate was 71% based on the method used in the North American Symptomatic Carotid Endarterectomy Trial, (b) cervical magnetic resonance imaging: examination revealed an unstable plaque with a major axis of 20 mm showing T1 (black blood) high intensity from the right common carotid artery to the proximal internal carotid artery.
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The stenosis rate was 71% based on the method used in the North American Symptomatic CEA Trial [Figure 1a].
Right common carotid angiography before and after carotid artery stenting (CAS). (a) Cervical angiography before CAS. Contrast media leaked from the injury site of the internal carotid artery (arrow), and the internal carotid artery distal to the injury point was severely stenotic due to hematoma compression (head arrow), (b) head angiography before CAS. Blood flow in the right middle cerebral artery was delayed, and the right anterior cerebral artery could not be visualized, (c) cervical angiography after CAS. The leakage of the contrast medium from the injury site decreased (arrow), (d) head angiography after CAS. Blood flow delay in the right middle cerebral artery improved, and the right anterior cerebral artery could be visualized.
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The internal carotid artery, distal to the injury site, presented with severe stenosis due to hematoma compression [Figure 2a]. The right anterior cerebral artery could not be visualized [Figure 2b]. Then, leakage of contrast medium from the injury site decreased [Figure 2c]. On the right common carotid angiography after CAS, blood flow delay in the right middle cerebral artery improved, and the right anterior cerebral artery could be visualized [Figure 2d].
Right common carotid arteriography on postoperative day 1. The arrow indicates the point where the contrast media leaked due to injury. Contrast media continued to leak from the injury point. However, it decreased.
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CAS on postoperative day (POD) 1 [Figure 3]. Cervical computed tomography scan images were obtained on POD 2 (without contrast), 3 (with contrast), and 6 (without contrast).
Postoperative cervical computed tomography. Increased blood mass was not observed. The arrow indicates the blood mass. (a) Postoperative day (POD) 2 (without contrast), (b) POD 3 (with contrast), (c) POD 6 (without contrast).
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However, there was no increased blood mass [Figures 4a-c].
Right common carotid arteriography on postoperative day 14. The arrow indicates the point where the contrast media leaked due to injury as shown in Figure 3. Contrast media leakage from the injury point disappeared.
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On DSA, the extravascular pooling of contrast media in the injury site disappeared on POD 14 [Figure 5].