PMC8247674_01
(a) Magnetic resonance (MR) angiography revealing mild stenosis with white plaque at the origin of the right internal carotid artery (ICA). (b and c) MR plaque imaging (T1-weighted fat suppression black blood) revealing a high-intense (b; sagittal, c; axial). (d) Three-dimensional computed tomographic angiography (CTA) revealing mild stenosis with ulcer formation at the origin of the ICA. (e) A sagittal CTA maximum intensity projection image demonstrating a carotid web lesion.
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Magnetic resonance angiography (MRA) revealed mild stenosis with white plaque at the origin of the right ICA [Figure 1a]. MR plaque imaging (T1-weighted fat suppression black blood) demonstrated a high intensity [Figure 1b and c]. Three-dimensional computed tomographic angiography (CTA) suspected ulcer formation [Figure 1d], and a sagittal CTA maximum intensity projection image demonstrated a carotid web lesion [Figure 1e].
(a and b) An operative photography demonstrating an unusual course of the vagus nerve passing anterior to the ICA. The internal jugular vein is retracted laterally. (c) The vagus nerve is moderately towed laterally with yellow silicone tape. An arteriotomy line is marked with Pyoktanin Blue. (d) The indocyanine green video angiography revealing vasa vasorum. (e) Lateral towing the vagus nerve with silicon tape has made the clamp of distal ICA and arteriotomy easier. X: Vagus nerve, XII; Hypoglossal nerve, CCA: Common carotid artery, ICA: Internal carotid artery, ECA: External carotid artery.
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ICA [Figure 2a and b]. Therefore, we performed the clamp of distal ICA and arteriotomy by moderate towing the vagus nerve with silicon tape [Figure 2c and d]. The vulnerable plaque associated with a shelf [Figure 2e] was excised intact.