PMC6479139_01
Computed tomography angiography of extracranial arteries. The image shows a 6-mm pseudoaneurysm of the left facial artery (arrow)
PJR-84-83004-g001.jpg
PMC6479139_01_PJR-84-83004-g001.jpg
f0001
Computed tomography angiography (CTA) of the neck revealed a 6-mm pseudoaneurysm of the left facial artery in the tonsillar fossa (Figure 1).
Digital subtraction angiography. A-B) The left vertebral artery (VA) selective angiography showed the presence of an occipital-vertebral anastomosis (arrow) between the muscular branch of the left VA and the left occipital artery with retrograde flow from the VA to the external carotid artery (ECA) in the segment above the ligation. C-D) Embolization of the trunk of the ECA was achieved by implantation of one platinum detachable coil (target 6 mm x 15 cm) and further injection of N-butyl-2-cyanoacrylate. The final angiogram (C) demonstrated subtotal occlusion of the embolized vessel with a negligible inflow by submillimeter muscular branches
PJR-84-83004-g002.jpg
PMC6479139_01_PJR-84-83004-g002.jpg
f0002
Selective angiography of the left vertebral artery (VA) showed the presence of an occipital-vertebral anastomosis with retrograde flow from the VA to the ECA in the segment above the ligation (Figure 2A-B). The trunk of the ECA was selectively catheterized with a Prowler 10 microcatheter (Codman, Raynham, U.S.) via the anastomosis and subsequent embolization with a platinum detachable coil (Target, Stryker, Fremont, U.S.) was accomplished (Figure 2C). The final angiogram demonstrated subtotal occlusion of the embolized ECA trunk (Figure 2D).
Magnetic resonance examination, axial T2-weighted (A), diffusion-weighted images (B) as well as T1-weighted images (C, D). The images show hyperintense regions of acute ischemic stroke involving predominantly the right thalamus as well as a small part of the left thalamus (A, B). On T1-weighted images (C, D) the P1 segments of both posterior cerebral arteries revealed high signal intensity more pronounced on the right side (arrows), probably due to P1 thrombus
PJR-84-83004-g003.jpg
PMC6479139_01_PJR-84-83004-g003.jpg
f0003
T2-weighted and FLAIR images involving almost the whole right thalamus with predominance of its anterior-medial portion and a small paramedian region within the left thalamus (Figure 3A). These regions showed restricted diffusion on diffusion-weighted images (DWI) compatible with acute ischemia (Figure 3B).