PMC4844669_01
Digital subtraction angiography (DSA): pre-operative DSA showed (A-B) stenosis at the bifurcation of right ICA and ACA with collateral vessels, (A) Towne's view, (B) lateral view. Pre-operative DSA showered (C-D) partially occluded left ICA and ACA with collateral vessel formation, (C) Towne's view, (D) lateral view. One month post-operative DSA showed development of leptomeningeal anastomosis on the left side (E, lateral view) and right side (F, lateral view).
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Diagnostic digital subtraction angiography (DSA) confirmed stenosis at the bifurcation of right ICA and anterior cerebral artery (ACA) with collateral vessels (Fig. 1). The left ICA and the ACA are partially occluded with collateral vessel formation (Fig. 1). Since the lesion on the left side is severe than the right side (Fig. 1, Fig. 2). One month post-operative DSA also demonstrated anastomosis patency (Fig. 1).
Computed tomography angiography (CTA) and CT perfusion (CTP): (A) pre-operative CTA. (B) two weeks post-operatiive CTA showed newborn compensatory proliferated vasculature. (C) preoperative CTP. (D) two weeks post-operative CTP showed increased cerebral blood flow.
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CT angiography (CTA) of the head was also performed with similar findings as the DSA (Fig. 2). Head CT perfusion (CTP) revealed a hypovolemic left cerebral hemisphere comparing to the right (Fig. 2). Head CTA 2 weeks post-operatively showed patent vascular anastomosis with newborn compensatory proliferated vasculature leading to improved CBF as demonstrated by the head CTP (Fig. 2).