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 64-year-old man presented to our hospital with visual loss on the left eye due to central retinal artery occlusion diagnosed by another ophthalmological hospital. Magnetic resonance imaging revealed small multiple cerebral infarctions on bilateral hemisphere. Transesophageal echocardiography was performed, which revealed a mass lesion like a tumor with calcification on the mitral valve. We suspected that a mass lesion is calcified amorphous tumor (CAT). Surgical resection of the mass lesion was performed, and it was diagnosed CAT by pathological examination. CAT is considered as high risk of cerebral embolism, surgical treatment should be considered as early as possible.
A 40-year-old man with a history of carotid artery stenting for symptomatic left internal carotid artery (ICA) dissection presented to our hospital to undergo treatment for spontaneous asymptomatic right internal carotid artery (ICA) dissection. Carotid angiogram revealed the dissection of the right ICA and formation of a dissecting aneurysm with a false lumen with blood flow. Transoral carotid ultrasonography (TOCU) revealed the entry and re-entry points of the false lumen with high blood flow, and the true lumen was stenosed secondary to the expanded false lumen. Carotid artery stenting of the right ICA was performed. Postoperative TOCU revealed loss of blood flow in the thrombosed false lumen, and the true lumen was expanded satisfactorily with no stenosis. TOCU allows evaluation of the extracranial ICA, which is not possible with conventional carotid artery ultrasonography. Our case suggests that pre-and post-evaluation by TOCU for carotid artery stenting in ICA dissection appears effective.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.