PMC8247690_01
Cerebral angiography of the left internal carotid artery (ICA) demonstrating severe stenosis of the left ICA at the distal cavernous-infraclinoid portion. The ocular artery was not confirmed (a). Cerebral angiography of the left common carotid artery before stent placement demonstrating the ocular artery (arrows) was depicted by a collateral blood flow from the external carotid system (b). Cerebral angiography of the left ICA after stent placement demonstrating the ocular artery (arrowhead) was depicted by a directed blood flow from the ICA (c).
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F1
Cerebral magnetic resonance imaging revealed a watershed infarction in the left hemisphere, and cerebral angiography revealed severe stenosis of the left intracranial ICA (distal cavernous-infraclinoid portion), without stenosis of the cervical ICA [Figures 1 and 2a]. Urgent cerebral angiography performed 2 days after the occurrence of visual impairment demonstrated that the left ICA was almost completely occluded, and the ocular artery was confirmed through anastomosis from the external carotid artery [Figure 1b]. After several attempts at PTA, an intracranial stent (Wingspan, Stryker Neurovascular, Salt Lake City, Utah, USA) was placed to maintain the improved flow of the ICA [Figure 1c].
Preoperative (a) and postoperative (b) fluorescent fundus angiography demonstrating the visualization of the retinal artery which improved markedly after the treatment.
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F2
Cerebral magnetic resonance imaging revealed a watershed infarction in the left hemisphere, and cerebral angiography revealed severe stenosis of the left intracranial ICA (distal cavernous-infraclinoid portion), without stenosis of the cervical ICA [Figures 1 and 2a]. The A-R time was reduced from 54 s to 11 s, and retinal angiography also showed improvement in the visualization of blood vessels [Figure 2a and b].
Preoperative single-photon emission computed tomography (SPECT) demonstrated that his left cerebral hemisphere reserve was reduced (a-c). Postoperative SPECT showed improvement in the left cerebral blood flow reserve (e-g). (a and d) Cerebral blood flow (CBF) at rest; (b and e) CBF after acetazolamide challenge (Diamox CBF); (c and f) cerebral vascular reserve defined as (Diamox CBF-resting CBF)/ resting CBFx100%).
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F3
In addition, SPECT showed improvement in the left cerebral blood flow reserve [Figure 3a-f], and he was discharged 2 weeks later without deficits.