PMC10159307_01
(a) Diffusion-weighted imaging on magnetic resonance imaging showed cerebral infarction in the right anterior cerebral artery area. (b) Brain magnetic resonance angiography showed right A2 occlusion (white arrow) and poor right middle cerebral artery blood flow (white arrowhead).
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F1
Brain magnetic resonance angiography (MRA) showed right A2 occlusion and poor visualized right MCA [Figure 1].
(a) Preoperative DSA of the right common carotid artery showing reticulated vessels developed from the proximal right MCA. Antegrade blood flow from the distal MCA was slow. The right A2 segment was not visualized. (b) Preoperative DSA of the left internal carotid artery showed right A2 near occlusion (white arrowhead). (c) Lateral view of preoperative DSA showed proximal right A2 near occlusion and distal right A2dissection (arrowhead). DSA: Digital subtraction angiography, MCA: Middle cerebral artery.
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F2
Emergent digital subtraction angiography showed right A2 near occlusion and reticulated vessels developed from the proximal right MCA [Figures 2a and b]. The lesion was considered dissection due to the presence of dilatation and string sign in retrospect [Figure 2c].
(a and b) DWI showed no newly infarction. (c) Brain MRA showed recanalization of the right A2 segment. (d) Basi-parallel anatomical scanning showed no right M1 form. (e) DWI 2 months later showed an enlarged infarction in the right ACA area. (f) Brain MRA showed right A2 restenosis. (g) Perfusion study of computed tomography scan showed a decrease in the cerebral blood flow at the right ACA and anterior middle cerebral artery. DWI: Diffusion-weighted imaging, MRA: Magnetic resonance angiography, ACA: Anterior cerebral artery.
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F3
The symptoms of the patient improved without any recoiling of MRI 1 week after the treatment, and the MRI showed no enlargement of the CI, and MRA showed adequate dilatation of the right A2 segment [Figures 3a-c]. Basi-pararel anatomical scanning showed no right M1 form [Figure 3d]. MRI showed worsening of stenosis in the right A2 segment and an increase in the right ACA area infarction [Figures 3e and f]. Since perfusion study of the CT scan showed a remarkable decrease in cerebral blood flow (CBF) in the right hemisphere was achieved [Figure 3g], we performed an additional endovascular treatment under general anesthesia 7 days after second admission.
(a) Right A2 restenosis before the second treatment. (b) Catalyst5 was inserted into the left A1 segment, and antegrade blood flow from the left A1 segment disappeared. (c) The bilateral A2 segment was described from the right A1 segment. (d and e) Catalyst5 was placed in the left A1 segment, and Wingspan was placed in the right A2 segment after stenting. (f) Wingspan was dilated on cone-beam computed tomography.
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F4
The right A2 segment was adequately dilated, and the flow of the right distal ACA was improved [Figure 4].
(a) Diffusion-weighted imaging showed no new infarction. (b) Computed tomography angiography showed recanalization of the right A2 segment.
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F5
Restenosis was not observed 6 months after stenting [Figure 5].