PMC4533340_01
Diffusion-weighted magnetic resonance imaging (MRI) and MR angiography of a 73-year-old male with acute onset of right hemiparesis and aphasia. a: Small acute infarction in the left middle cerebral artery territory revealed by MRI. b: MR angiography shows occluded left cervical internal carotid artery.
nmc-55-248-g1.jpg
PMC4533340_01_nmc-55-248-g1.jpg
F1
Assessment by MRI revealed a new infarction in the left middle cerebral artery (MCA) territory (Fig. 1a), and MR angiography showed left internal carotid artery (ICA) occlusion (Fig. 1b).
Angiography findings. Common carotid angiography confirmed occluded cervical portion of internal carotid artery (a). Carotid stenting under proximal balloon protection (b) resulted in recanalization (c). Left internal carotid angiography shows persistently occluded middle cerebral artery (d). Balloon angioplasty (e) resulted in reperfusion (f).
nmc-55-248-g2.jpg
PMC4533340_01_nmc-55-248-g2.jpg
F2
Digital subtraction angiography (DSA) revealed persistent left ICA occlusion (Fig. 2a). A total of 5,000 IU heparin was intravenously administered, and initial carotid artery stenting proceeded under proximal balloon protection (Fig. 2b). Thereafter, the ICA was dilated (Fig. 2c), but the left MCA occlusion persisted (Fig. 2d). The MCA was dilated with a balloon catheter (Fig. 2e), which resulted in complete recanalization (Fig. 2f).
Imaging findings 1 day later. a: Enlargement of infarction is not evident on MRI and b: MR angiography shows patent left internal carotid and middle cerebral arteries. MRI: magnetic resonance imaging.
nmc-55-248-g3.jpg
PMC4533340_01_nmc-55-248-g3.jpg
F3
Assessment by MRI at 7 days after onset showed limited infarction in the frontal lobe (Fig. 3a) and MR angiography showed a patent left MCA (Fig. 3b).