PMC4508713_01
Right common carotid angiography of anteroposterior (A-P) view. A: Initial angiography before treatment showing the right internal carotid artery severe stenosis. B: Angiography immediately after previous carotid artery stenting (CAS) revealing a well-expanded stenotic lesion. C: Follow-up angiography 9 months after the CAS, showing slight in-stent restenosis. D: Follow-up angiography 6 years after the CAS, demonstrating diffuse in-stent restenosis and the expanded previous stent.
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F1
He underwent CAS 10 years ago, under the distal balloon protection technique because of right internal carotid artery stenosis with amaurosis fugax of the right eye (Fig. 1A, B). There was slight evidence of ISR upon follow-up carotid angiography (CAG) 9 months after the previous CAS (Fig. 1C). Thereafter, a follow-up carotid ultrasonography and the CAG showed gradually progressive ISR of the right carotid artery (Fig. 1D).
A: Magnetic resonance imaging demonstrating ischemic lesion (arrow) on the right cerebral hemisphere. B: Cervical ultrasound image showing intimal thickness with low-echoic signal (arrow). C: Angiography on admission revealing more progressive in-stent restenosis and previous stent enlargement.
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F2
Magnetic resonance imaging on this admission demonstrated newly ischemic lesions on the right cerebral hemisphere (Fig. 2A). Carotid ultrasonography also demonstrated significant intimal thickness with a hypoechoic signal (Fig. 2B). The CAG revealed evidence of progressive diffuse in-stent stenosis and previous stent enlargement (Fig. 2C).