PMC9479608_01
(a) Neck MRA revealing severe stenosis of the proximal left internal carotid artery (ICA) (arrow), and undetected external carotid artery. (b) Intracranial MRA displaying weak flow signal intensity of the left ICA and left middle cerebral artery (MCA) (arrow). (c) MRI FLAIR showing hyperintense vessel sign in the left MCA. (d) Neck noncontrast CT demonstrating severe circular calcification (arrow). (e and f) 123I-iodoamphetamine single-photon emission computed tomography showing reductions in cerebral blood flow (CBF) and (f) CBF to acetazolamide in the left hemisphere.
SNI-13-360-g001.jpg
PMC9479608_01_SNI-13-360-g001.jpg
F1
Neck MRA demonstrated severe stenosis of the proximal left internal carotid artery (ICA), and the external carotid artery was not detected [Figure 1a]. Intracranial MRA showed weak flow signal intensity of the left ICA and left middle cerebral artery [Figures 1b and c], and neck computed tomography revealed severe circular calcification [Figure 1d]. 123I-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT), additionally, showed reduced CBF and cerebral vascular reserve [Figures 1e and f] in response to acetazolamide in the left hemisphere.
(a) Left common carotid artery angiography before first-stage percutaneous transluminal angioplasty (PTA) showing slow flow in the internal carotid artery (ICA), and occlusion of the left external carotid artery. (b) PTA being performed. (c) Improved flow within the ICA. (d) Improvements in the left hemisphere cerebral blood flow through 123I-iodoamphetamine single-photon emission computed tomography, but with impairments still detected.
SNI-13-360-g002.jpg
PMC9479608_01_SNI-13-360-g002.jpg
F2
After expanding the stenotic lesion, we observed that flow delay was improved [Figures 2a-c]. Two days after first stage PTA, 123I-IMP SPECT revealed improvements in CBF [Figure 2d].
(a) Operative view of carotid endarterectomy (CEA) showing calcified plaque and thrombus formation proximal to the plaque. (b and c) Improvements in intracranial and neck MRA following CEA. (d) 123I-iodoamphetamine single-photon emission computed tomography 2 days after CEA showing normalized cerebral blood flow. (e) H-E stain of thrombosis revealing mostly intact and partially lytic blood cells, without necrotic tissue.
SNI-13-360-g003.jpg
PMC9479608_02_SNI-13-360-g003.jpg
F3
A hematoxylin-eosin stain of the thrombus showed mostly intact and partially lytic blood cells, without necrotic tissue [Figure 3e].
PMC9479608_02
(a) Operative view of carotid endarterectomy (CEA) showing calcified plaque and thrombus formation proximal to the plaque. (b and c) Improvements in intracranial and neck MRA following CEA. (d) 123I-iodoamphetamine single-photon emission computed tomography 2 days after CEA showing normalized cerebral blood flow. (e) H-E stain of thrombosis revealing mostly intact and partially lytic blood cells, without necrotic tissue.
SNI-13-360-g003.jpg
PMC9479608_02_SNI-13-360-g003.jpg
F3
A hematoxylin-eosin stain of the thrombus showed mostly intact and partially lytic blood cells, without necrotic tissue [Figure 3e].