PMC9899451_01
(a) Carotid magnetic resonance angiography: 2 years after surgery. There is no obvious stenosis in the right carotid artery (arrow). (b) The right cervical computed tomography angiography: 3 years after surgery. There is no obvious stenosis in the artificial vessel at 3 years after surgery. The arrowhead indicates each end of the anastomosis. (c) Carotid magnetic resonance angiography: 4 years after surgery, The stenosis of the right carotid artery is observed (arrow).
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F1
Four years after the surgery, MRA showed suspicious stenosis in the artificial vessel [Figure 1c], and antiplatelet medication (aspirin 100 mg) was administered.
PMC9899451_02
(a) Carotid magnetic resonance angiography: 2 years after surgery. There is no obvious stenosis in the right carotid artery (arrow). (b) The right cervical computed tomography angiography: 3 years after surgery. There is no obvious stenosis in the artificial vessel at 3 years after surgery. The arrowhead indicates each end of the anastomosis. (c) Carotid magnetic resonance angiography: 4 years after surgery, The stenosis of the right carotid artery is observed (arrow).
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F1
Four years after the surgery, MRA showed suspicious stenosis in the artificial vessel [Figure 1c], and antiplatelet medication (aspirin 100 mg) was administered.
Carotid artery echocardiography (a: 4 years after surgery, b: 6 years after surgery, arrow head: proximal anastomotic site). (a) The stenosis is recognized inside the vessel graft. The peak systolic velocity is 242 cm/s. (b) The stenosis is progressed as seen during the follow-up. The PSV is 255 cm/s. The lumen of the prosthesis shows isointense intimal thickening, and the stenosis is clearly progressive.
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F2
Carotid ultrasonography showed intimal thickening with isointense fibrous tissue in the vessel, and the peak systolic velocity (PSV) was 242 cm/s [Figure 2a] in the most stenotic portion. The PSV of the stenosis 2 years after the previous examination was increased to 255 cm/s on ultrasonography [Figure 2b], and stenosis had clearly progressed.
(a) Carotid magnetic resonance angiography: 6 years after surgery. The right carotid artery is suspected obstruction (arrowhead). (b) The right cervical computed tomography angiography: 6 years after surgery. The arrowhead indicates each end of the anastomosis. Six years later, the stenosis is observed at the non-anastomotic area (arrow). (c) Carotid magnetic resonance angiography: Just before IVR. The right carotid artery was further poorly delineated. (d) The right cervical computed tomography angiography: Just before IVR. The stenosis progressed just before treatment (arrow). The arrowhead indicates each end of the anastomosis.
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F3
The common carotid artery was difficult to detect on the cervical MRA [Figure 3c]; however, CTA revealed severe stenosis [Figure 3d] immediately before the treatment.
PMC9899451_03
(a) Carotid magnetic resonance angiography: 6 years after surgery. The right carotid artery is suspected obstruction (arrowhead). (b) The right cervical computed tomography angiography: 6 years after surgery. The arrowhead indicates each end of the anastomosis. Six years later, the stenosis is observed at the non-anastomotic area (arrow). (c) Carotid magnetic resonance angiography: Just before IVR. The right carotid artery was further poorly delineated. (d) The right cervical computed tomography angiography: Just before IVR. The stenosis progressed just before treatment (arrow). The arrowhead indicates each end of the anastomosis.
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F3
The common carotid artery was difficult to detect on the cervical MRA [Figure 3c]; however, CTA revealed severe stenosis [Figure 3d] immediately before the treatment.
PMC9899451_04
(a and b) Preoperative brachiocephalic angiography (a: AP view, b: Lateral view). (b) The right common and internal carotid artery was pseudo-occluded up to the intracranial area (arrow head). (c and d) Postoperative common carotid arteriography (c: AP view, d: Lateral view), (d) The stenosis was well dilated with the stent.
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F4
Common carotid angiography showed pseudo-occlusion of the stenosis [Figures 4a and b]. In the final image, the stenosis was well dilated, and the common carotid artery and intracranial internal carotid artery were well visualized [Figures 4c and d].
Postoperative Carotid ultrasonography. The stenosis is successfully dilated (Arrow heads: stent proximal end, arrow: stand distal end). The peak systolic velocity is decreased down to 93.4 cm/s. There is no change in the outer diameter of the artificial blood vessel (4 mm).
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F5
Carotid ultrasonography showed that the outer diameter of the artificial vessel did not change, but the stenosis inside the artificial vessel was dilated [Figure 5].