Internal Carotid Artery Stenosis

Figure 1: Ischemic cerebral changes are seen in centrum semiovale and left parietal cortex (top row: brain MRI/FLAIR). Cerebral perfusion imaging with increased Tmax in the left hemisphere (CT perfusion; bottom).

The patient was placed on ASA, statin, and antihypertensive medication. On baseline conventional angiogram, there was reduced visualization of intracranial arteries due to a high-grade left internal carotid artery stenosis. Carotid angioplasty and stenting was performed to restore intracranial circulation with excellent radiological and clinical outcome (Figures 2).

Figure 2: 58-year-old man with symptomatic high-grade stenosis of the proximal left internal carotid artery (ICA) (filling defect market as yellow,* top middle). Pre-operative, reduced filling of the left middle cerebral artery (M) and no filling of the anterior cerebral artery (A) (top left). External carotid artery branches, superficial temporal and middle meningeal arteries filling ahead of the intracranial circulation on the cerebral angiogram (left). Carotid angioplasty and stenting (center) with restitution of carotid lumen post-op (bottom middle) and restoration of intracranial flow with visualization of branches of middle and anterior cerebral arteries (right).