PMC10355127_01
a MR angiography: occlusion of the left intracranial tract of the internal carotid artery and multiple severe intracranial stenosis. b CT perfusion: large area of ischemic penumbra in the territory of the left MCA. c Angiography: complete recanalization after intracranial stenting in distal carotid siphon-left MCA.
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F1
A transcranial color-coded duplex (TCCD), a CT angiography, and an MR angiography were performed and showed multiple severe intracranial arterial stenosis involving the left carotid terminus, the right carotid terminus, the anterior and the posterior cerebral artery bilaterally, with post-stenotic aneurysmal dilatations (Fig. 1a). This clinical evolution occurred under combined therapy with a high dose of steroids, immunosuppressant, and antithrombotic therapy, and a new brain CT perfusion exam showed a worsening of the left hemispherical hypoperfusion (Fig. 1b). An intracranial stent, Solitaire  (Medtronic), was positioned from the distal tract of the carotid siphon to the first tract of the MCA on the left side, without any procedural complication (Fig. 1c).
PMC10355127_02
a CT angiography: severe stenosis in the A1 tract of the left ACA and occlusion of the M1 tract of the left MCA. b CT perfusion: large area of ischemic penumbra in the territory of the left MCA. c Angiography: complete recanalization after intracranial stenting from the distal carotid siphon to the M1 segment of the left MCA. ACA, anterior cerebral artery.
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F2
A brain CT, a CT angiography, and a CT perfusion study were repeated, with evidence of complete occlusion of the terminal segment of the left ICA and of the proximal M1 segment of the ipsilateral MCA, compatible with occlusion in correspondence with the known pre-occlusive stenosis of the left MCA (Fig. 2a). The CT perfusion documented a large area of ischemic penumbra in the territory of the left MCA (Fig. 2b). The patient was treated with endovascular treatment, and an intracranial stent Solitaire  (Medtronic) was positioned in correspondence with the ophthalmic tract of the ICA and the M1 tract of the left MCA (Fig. 2c).