PMC7332696_01
(a) Initial diffusion-weighted imaging showed a hyperintense area in the left middle cerebral artery (MCA) territory. (b) Magnetic resonance angiography (MRA) showed that the right internal carotid artery (ICA) was nearly occluded and the left ICA was fully occluded. The left distal MCA could not be detected using MRA. (c) The intimal flap (white arrow) was detected in the bilateral cervical ICA.
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MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA [Figure 1].
(a) Digital subtraction angiography showed an occlusion in the cervical portion of the left internal carotid artery (ICA) (white arrow). (b) Carotid artery stenting (CAS) was performed for the left ICA followed by percutaneous transluminal angioplasty (PTA). The proximal and distal edges of the stent are represented with a white arrow. The left styloid process (black arrow) was close to the left ICA. (c) The right ICA was nearly occluded (white arrow). (d) PTA and CAS were also performed on the right ICA. The proximal and distal edges of the stent are represented with white arrows. The right styloid process was also close to the right ICA.
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Subsequently, CAS was performed on the right ICA after the flow deteriorated [Figure 2].
Cone-beam computed tomography after carotid artery stenting showed that the left carotid stent was close to the elongated styloid process (white arrow) according to the 3D (a) and axial images (b). (c) The fusion image between the neutral position (red skull) and the left rotation (white skull) shows forward movement (white double arrows) of the carotid stent. (d) The movement was more remarkable (white double arrows) in the fusion image between neutral position (red skull) and right rotation (white skull).
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Specifically, they were positioned very closely together, especially on the left side [Figure 3].