Transoral carotid ultrasonography (TOCU) is a powerful tool for evaluating the high internal carotid artery (ICA). Multiple reports have documented its excellent ability to show dissection of the high ICA. Superb microvascular imaging (SMI) is a new Doppler imaging technique that reduced motion artifacts and allows visualization of low-velocity blood flow in vessels. A 45-year-old man with aphasia and right hemiplegia was brought to our hospital. MRI showed acute cerebral infarction, and he was treated by recombinant tissue plasminogen activator (rt-PA). A carotid angiogram showed the dissection of the left extracranial ICA, and carotid artery stenting of the left ICA was performed. Postoperative SMI-TOCU showed that blood flow was preserved with no stenosis. It seemed that a part was missing. This was caused by slight turbulence caused by the step of the stent. The present case suggests that post-procedure evaluation by SMI-TOCU for carotid artery stenting in ICA dissection may be useful.
A 71-year-old woman was admitted to our hospital with an acute Stanford type A aortic dissection. She underwent tricuspid valve plasty and ascending aorta repair. On day 7 she presented with aphasia. Brain computed tomography (CT) revealed a low-density area in the left frontal lobe. Carotid Doppler ultrasonography disclosed that the left common carotid artery was occluded up to a point just proximal to the carotid bifurcation, and retrograde flow was seen from the external carotid artery (ECA) to the internal carotid artery via the carotid bifurcation. These findings suggested a collateral anastomosis between the ECA and the vertebral artery. Four-dimensional CT angiography is sufficiently effective for evaluation of occipital-vertebral anastomosis.
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