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AJNR - American Journal of Neuroradiology

Published ahead of print on October 5, 2007
doi: 10.3174/ajnr.A0706

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Concomitant Multiple Revascularizations in Supra-Aortic Arteries: Short-Term Results in 50 Patients

H.W. Pyun^b, D.C. Suh^b, J.K. Kim^a, J.S. Kim^c, Y.J. Choi^b, M.-H. Kim^b, H.R. Yang^b, Y.M. Jang^b, M.-S. Ko^b, E.Y. Cha^b, D.H. Yang^b and S.J. Kim^b

^a Department of Radiology, Seoul Veterans Hospital, Seoul, Korea
^b Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
^c Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea

View larger version (101K): [in this window] [in a new window]   Fig 1. A 66-year-old man with hypertension and a history of smoking presented with chest pain and vertigo and was found to have multiple stenoses (ipsilateral remote tandem lesions) before coronary artery bypass surgery. A–B, The severe stenosis in the right carotid bulb with undermining ulceration (arrow), was revascularized first (anteroposterior view). C–D, Concomitant severe (more than 70%) stenosis (arrow in C) of the right cavernous segment was also revascularized during the same session. Note antegrade filling of the ophthalmic artery (open arrow in D). The patient underwent coronary artery bypass surgery and had no neurologic symptoms during the 6-month follow-up period.

View larger version (93K): [in this window] [in a new window]   Fig 2. A 50-year-old man presented with vertigo, ataxia, and right arm weakness. An angiogram of the left CCA revealed a symptomatic severe stenosis of the left carotid bulb (arrow) (A) and patency after stent placement (B). There were multiple severe stenoses (arrows) of the right CCA (adjacent tandem lesions) (C). Good patency was obtained after concomitant stent placement (D). He underwent additional angioplasty at the right CCA at 18 months because of asymptomatic severe restenosis (not shown) and remains asymptomatic during a 32-month follow-up period.

View larger version (71K): [in this window] [in a new window]   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.