PMC10413567_01
Preoperative multimodal neuroimaging evaluation. (A) Intracranial hemorrhage was excluded through computed tomography (CT). (B) Cross-sectional contrast CT revealed abnormal anastomosis (arrow) between the internal carotid artery (ICA) and the intracranial segment of the vertical artery (VA) located in the atlantooccipital space. (C) CT angiography (anterior-posterior view) showed basilar artery occlusion (arrowhead) and that right VA (arrow) originated from the ICA. (D) Volumes of infarct core (red area) and penumbra (green area) were evaluated automatically from CT perfusion to calculate the mismatch volume. (E) Right hemispheric angiography showed complete occlusion of the middle segment of the basilar artery (arrowhead) and that persistent hypoglossal artery (PHA) (arrow) originated from the right ICA. (F) Right subclavian artery angiography showed the absence of VA origin. (G) Left middle cerebral artery occlusion was observed with collateral vessel formation. (H) Slender left VA (arrowheads) demonstrated in left hemispheric angiography.
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F1
Multimodal computed tomography (CT) was performed, and intracranial hemorrhage was excluded (Figure 1A). CT angiography (CTA) showed the absence of the basilar artery (BA) and an abnormal anastomosis between the internal carotid artery (ICA) and the intracranial segment of the vertebral artery (VA) located in the hypoglossal canal (Figures 1B, C). The mismatch volume was 104 mL (Figure 1D), determined using MIStar software (Apollo Medical Imaging Technology, Melbourne, Australia). Left middle cerebral artery occlusion with collateral vessel formation and a slender left VA were also observed (Figures 1E-H).