Extract

This eighty-five-year-old woman had a long history of hypertension, non-insulin dependent diabetes mellitus, and lower extremity claudication. Five years ago, she was hospitalized for stroke. Physical examination was notable for a left sided carotid bruit. There were no residual neurologic deficits. Serial carotid artery flow studies with color flow duplex Doppler showed hemodynamically significant and progressive obstruction to flow in the left internal carotid artery. The patient underwent MRA of the neck with administration of intravenous contrast utilizing a 3D time of flight sequence (illustrated above). The left panel illustrates the neck and cerebral circulation. Arrow A shows a severe stenosis of the left internal carotid artery. Arrow B shows a less severe stenosis of the right internal carotid artery. The right panel shows a close-up view of the left internal carotid artery illustrating a >95% stenosis (arrow A) with decreased flow in the more distal and coiling artery (Fig.1).

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