PMC3290011_01
a Angiography: post-stenting right common carotid artery (RCCA; lateral view). b Angiography: post-stenting left common carotid artery (LCCA) with injection to the left ICA demonstrating opacification of the right anterior cerebral artery due to a tiny ACOM (anteroposterior view).
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F1
A tiny anterior communicating artery (ACOM) with no bilateral posterior communicating artery (PCOM) was demonstrated (fig. 1a, b, brain angiography). Stenting of both ICA (two stents each side) was performed restoring flow bilaterally with normal parenchymal blush (fig. 1a, b, fig. 3).
a Distal LCCA dissection (lateral view). b Distal RCCA dissection (anteroposterior view).
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F2
He was taken to the angiography room: under general anesthesia four vessels angiography was performed demonstrating near complete occlusion of the right ICA and severe stenosis of the left ICA due to BICAD in the cervical area (fig. 2a, b).
Post-stenting watershade infarct due to hypoperfusion.
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F4
Two days following stenting, a subcortical small watershade infarct was demonstrated on a CT (in the para-midline ACA-MCA passage) further supporting that hypoperfusion was the underlying cause (fig. 4).