Fig 3. A 45-year-old male presented after multiple TIAs. Adjacent tandem lesions of the right MCA, are revealed by the arrows in A and B. A, The initial MRA showed a severe stenosis of right M1 (arrow in A) and failed to demonstrate an adjacent distal tandem lesion because of the decreased signal intensities distal to the first stenotic lesion. B, The oblique CT angiogram shows both severe tandem lesions (arrows) with more than 70% stenosis. C, There was an increased time-to-peak delay on CT perfusion image in the right MCA territory. D, The M1 lesion did not seem to be severe (arrow) on the anteroposterior view of cerebral angiogram due to the marked eccentricity of the M1 lesions. E, Final angiogram after concomitant stenting revealed good patency of the right M1 and improved angiographic flow into the right MCA territory. F, Diffusion-weighted MR imaging performed 2 days later, revealed acute ischemic change in the right caudate nucleus. The newly developed mild extremity weakness (minor stroke) eventually disappeared completely. There was no evidence of restenosis on TCD at 7 months and no symptomatic recurrence during the 17-month follow-up.