PMC3502825_01
In native scan and with duplex mode, an irregular membrane crossing the vessel with a true and a false lumen was observed.
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fig1
Although the acute incident happened 5 months ago, in carotid artery duplex scanning, an irregular membrane crossing the vessel with a true and a false lumen was still observed (Figure 1).
High-grade stenosis of the right common carotid artery (CCA).
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fig2
Moreover, a high-grade stenosis of the right common carotid artery with a peak systolic velocity (PSV) of up to 362 cm/sec was revealed (Figure 2).
Considerably reduced PSV in the right ICA (automatic detection shows a normal PSV due to the measurement of poststenotic turbulences).
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fig3
Furthermore, the PSV was considerably reduced in the right ICA as a clear sign of haemodynamic significance (Figure 3).
Hypoperfusion in brain area corresponding to the right MCA.
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MR imaging demonstrated hypoperfusion in brain area corresponding to the right MCA (Figure 4) as a sign of haemodynamic impairment in impending watershed infarction.
Obvious low flow in right distal ICA.
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Right distal ICA was clearly less contrasted in MR angiography as an indirect sign of the upstream stenosis of right CCA (Figure 5).
Reduced flow in the right MCA with a cross flow from the left hemisphere.
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Finally, the intracranial MR angiography revealed an insufficient cross flow from the left to the right side via the anterior circulation and via ramus communicans posterior resulting in a reduced flow in the right MCA (Figure 6).
Known dissection Stanford type A with transmitted dissection membrane in brachiocephalic artery, subclavian artery on both sides, and left CCA.
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fig7