PMC9869383_01
Admission brain magnetic resonance imaging showing acute cerebral infarction.
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F1
After admission, the patient was subjected to a high-resolution magnetic resonance examination of the brain, which suggested that there were multiple acute infarction lesions under the left cerebral cortex and beside the lateral ventricle, following which hypoperfusion infarction was considered (Figure 1).
Digital subtraction angiography (DSA) image after admission. (A) DSA from the right common carotid artery showing that the anterior communication is open and compensated from right to left. (B) Severe stenosis of the C1 segment of the right internal carotid artery. (C) DSA of the left common carotid artery showing an occlusion of the common carotid artery. (D,E) Postoperative angiography of the right CAS showing an improvement of right to left blood flow compensation. CAS, carotid artery stent implantation.
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A digital subtraction angiography showed that the left common carotid artery was occluded, the left subclavian artery was extremely narrowed (~90%), the left vertebral artery opening was narrowed (~50%), the left posterior cerebral artery supplied blood to the left middle cerebral artery supply area through the pia mater, the V1 segment of the right vertebral artery was occluded, the C1 segment of the right internal carotid artery was extremely narrowed (~80%), and the right anterior communication was open (Figure 2).
(A) Spectrum results of the bilateral middle cerebral artery detected by TCD after CAS. (B) Spectrum results of the bilateral middle cerebral artery detected by TCD before the operation. TCD, transcranial Doppler ultrasound; CAS, carotid artery stent implantation.
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TCD showed that the flow velocity of the middle cerebral artery had changed little before and after the operation (Figure 3). The brain CT showed no hemorrhage and obvious swelling of the cortex, and CHS was preliminarily excluded (Figure 4A).
(A) Brain CT images were reexamined on the day after CAS. (B) On the third day after CAS, the brain CT image was reexamined (the low-density focus showing a greater enlargement than before). CAS, carotid artery stent implantation.
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TCD showed that the flow velocity of the middle cerebral artery had changed little before and after the operation (Figure 3). The brain CT showed no hemorrhage and obvious swelling of the cortex, and CHS was preliminarily excluded (Figure 4A). Upon a reexamination of the brain CT, it could be seen that there was an enlargement of the low-density focus beside the left lateral ventricle (Figure 4B).
MR perfusion-weighted imaging (PWI) after carotid artery stent implantation (CAS). [PWI showing a lower cerebral blood volume (CBV) and cerebral blood flow (CBF) in the left hemisphere than those in the right hemisphere, while the time to peak (TTP) and mean transit time (MTT) are significantly higher.]
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On the second day, MRI cerebral perfusion was done, which revealed a decrease in perfusion in the left frontotemporal lobe which was more severe than that before surgery (Figure 5).
Timeline with relevant blood pressure data.
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A timeline with relevant blood pressure data is shown in Figure 6.