PMC9990815_01
Perioperative images of thrombectomy performed 1-year ago. (a) Preoperative CTA showing left ICA occlusion. (b and c) Preoperative angiography showing occlusion of the left ICA and collateral vessels in the C2 portion of the ICA from the external carotid artery and ophthalmic artery to the distal ICA (b: frontal view, c: lateral view). (d and e) Postoperative angiography showing TICI 2b recanalization and WASID 68% stenosis in the C3 portion of the left ICA (d: frontal view, e: lateral view). (f) Magnetic resonance angiography the day after thrombectomy showing the patency of the left ICA. ICA: Internal carotid artery, TICI: Thrombolysis in cerebral infarction, WASID: Warfarin-aspirin symptomatic intracranial disease.
SNI-14-75-g001.jpg
PMC9990815_01_SNI-14-75-g001.jpg
F1
Computed tomography-angiography (CTA) showed left ICA occlusion [Figure 1a]. Angiography showed occlusion of the left ICA and collateral vessels in the C2 portion of the ICA from the external carotid artery and ophthalmic artery [Figures 1b and c]. A stent retriever was used to retrieve the thrombus in the C3 portion of the ICA, and thrombolysis in cerebral infarction 2b recanalization was achieved [Figures 1d and e]. Stenosis of Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) 68% was observed at the C3 portion of the ICA [Figure 1e], but no additional treatment was performed, because blood flow distal to the stenosis was excellent. Postoperatively, she made a full recovery, and magnetic resonance angiography (MRA) the day after thrombectomy showed the patency of the left ICA [Figure 1f].
Perioperative images of initial percutaneous transluminal angioplasty. (a) Preoperative MRA showing reduced blood flow signals in the left ICA and left MCA. (b) Preoperative angiography showing severe stenosis of WASID 92% in the C3 portion of the left ICA with proximal ICA collapse and blood flow delay in the left MCA region. (c) Postoperative angiography showing dilatation of the stenosis (WASID 71%) and disappearance of blood flow delay in the left MCA region. (d) MRA the day after PTA showing increased blood flow signals in the left ICA and left MCA compared to preoperative ones, but the left-right asymmetry in ICA diameters remained. (e) MRA 5 days after PTA showing increased blood flow signals in the left ICA. (f) MRA 11 days after PTA showing maintenance of increased blood flow signals in the left ICA. MRA: Magnetic resonance angiography, ICA: Internal carotid artery, MCA: Middle cerebral artery, PTA: Percutaneous transluminal angioplasty, WASID: Warfarin-aspirin symptomatic intracranial disease.
SNI-14-75-g002.jpg
PMC9990815_01_SNI-14-75-g002.jpg
F2
Magnetic resonance imaging (MRI) showed scattered cerebral infarctions in the left cerebral hemisphere, and MRA showed reduced blood flow signals in the left ICA and left middle cerebral artery (MCA) [Figure 2a]. Although the left ICA maintained antegrade blood flow, severe stenosis of WASID 92% at the C3 portion of the ICA with proximal ICA collapse and blood flow delay in the left MCA region were observed [Figure 2b]. Angiography confirmed dilatation of the stenosis (WASID 71%) and disappearance of blood flow delay in the left MCA region, and the operation was completed [Figure 2c]. MRI showed no enlargement of the infarcted area, and MRA showed increased blood flow signals in the left ICA and left MCA compared to preoperatively, but the left-right asymmetry in the ICA diameters remained [Figure 2d]. MRA 5 days after PTA showed further increased blood flow signals in the left ICA and dilation of proximal ICA collapse [Figure 2e]; and MRA 11 days after PTA confirmed maintenance of increased flow signals in the left ICA [Figure 2f].
Perioperative images of second percutaneous transluminal angioplasty. (a) Preoperative angiography showing dilatation of proximal ICA collapse and improvement of vascular tortuosity. (b) Postoperative angiography showing dilatation of stenosis (WASID 55%). (c) Magnetic resonance angiography the day after stenting showing good blood flow in the left ICA. (d) Angiography 6 months after stenting showing further improvement of proximal ICA collapse. ICA: Internal carotid artery, WASID: Warfarin-aspirin symptomatic intracranial disease.
SNI-14-75-g003.jpg
PMC9990815_01_SNI-14-75-g003.jpg
F3
Angiography showed dilation of proximal ICA collapse and improvement of vascular tortuosity [Figure 3a]. Angiography showed dilatation of stenosis (WASID 55%) [Figure 3b]. MRA the day after stenting showed good blood flow in the left ICA [Figure 3c]. Six months later, MRA and angiography showed further dilated proximal ICA collapse [Figure 3d]; angiography showed no restenosis at the C3 portion of the left ICA.