PMC4762695_01
MRA of the neck showing the anomalous anastomosis of the right vertebral artery to the internal carotid artery segment 2.0 cm distal to the right common carotid artery bifurcation.
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FIG1
MRA of the head and neck was then obtained and showed an anomalous anastomosis of the right vertebral artery to the internal carotid artery segment 2.0 cm distal to the right common carotid artery bifurcation (Figure 1).
Oblique right common carotid artery injection before stent placement showing 1.3 cm length of plaque and greater than 60% diameter stenosis of the ICA segment proximal to the anomalous bifurcation.
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FIG2
Just proximal to the ICA-PPHA bifurcation, there was a 1.3 cm length of plaque resulting in greater than 60% diameter stenosis (Figures 2-3).
3D reconstruction identifying the anomalous vessel and proximal plaque.
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FIG3
Just proximal to the ICA-PPHA bifurcation, there was a 1.3 cm length of plaque resulting in greater than 60% diameter stenosis (Figures 2-3).
Oblique right common carotid artery injection after stent placement showing a restored normal luminal diameter and good flow across the ICA.
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FIG4
After placement of a SpiderFx  embolic protection device into the PPHA, a 7 x 10 x 40 mm Protege stent was deployed successfully across the stenotic segment and resulted in complete restoration of luminal diameter without the need for angioplasty (Figure 4).