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Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Select axial non contrast head CT image slice shows no attenuation change compatible with right hemispheric infarction. No dense right middle cerebral artery sign compatible with thrombus is identified (black arrow).

Technique: Axial CT mA330, 140 kV, Slice thickness 2.5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Axial contrast enhanced CTA of the head and neck; At the level of the supra-aortic branch vessels, occlusion of the innominate artery. Origin of the left vertebral artery from the aortic arch. At the level of the C1 vertebral body, marked diminution in caliber of the right internal carotid artery, relative to the left. At the level of the centrum semi ovale, increased cortical branch vessels on the right, relative to the left compatible with pial collaterals.

Technique: Axial CT, 480mAs, 140kV, Slice thickness 0.63mm, 75 ml Isovue 370 injection at 4ml/second.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.


Findings: Maximum intensity projection CTA shows patent right carotid terminus and right proximal middle cerebral artery.

Technique: Axial CT, 480mAs, 140kV, Slice thickness 10mm, 75 ml Isovue 370 injection at 4ml/second

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Coronal MIP reformat CTA demonstrates a normal caliber and contour of the right distal common carotid artery, carotid bifurcation and internal carotid artery.

Technique:: Axial CT, 480mAs, 140kV, Slice thickness 10mm, 75 ml Isovue 370 injection at 4ml/second.

Click
A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Curved planar sagittal reformat CTA demonstrates a normal caliber and contour of the right distal common carotid artery, carotid bifurcation and internal carotid artery.

Technique: Axial CT, 480mAs, 140kV, Slice thickness 0.63, 75 ml Isovue 370 injection at 4ml/second.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Sagittal MIP projection CTA shows patent right carotid terminus and right proximal middle cerebral artery.

Technique: Axial CT, 480mAs, 140kV, Slice thickness 10mm, 75 ml Isovue 370 injection at 4ml/second.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Select axial T2 sequence slice shows no signal change compatible with right hemispheric infarction.

Technique: Axial T2, TR 5.05 TE119.20, Slice thickness 5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Select axial FLAIR sequence slices show no signal change compatible with right hemispheric infarction.

Technique: Axial FLAIR TR 8000 TE 128.90, Slice thickness 5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Select coronal sequence slices show no signal change compatible with right hemispheric infarction.

Technique: TR 4300 TE133.90, Slice thickness 5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Sagittal T1 sequence slices show no signal change compatible with right hemispheric infarction.

Technique: Sagittal T1 74.50, TE80 74.50, Slice thickness 5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Diffusion axial slice sequences show no signal change compatible with right hemispheric infarction.

Technique: Axial Diffusion, TR8600 TE80.10, Slice thickness 5mm.

Click 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Select axial apparent diffusion coefficient (ADC) sequence slices show no signal dropout compatible with a right hemispheric infarct.

Technique: Axial Diffusion Coefficient mapped sequence, TR8600 TE80.10, Slice thickness 5mm.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: A: Aortic arch angiography shows occlusion of the innominate artery and retrograde flow within the right vertebral artery and delayed retrograde distal innominate artery flow (dotted arrow) and subsequent anti-grade flow into the right common carotid artery and internal carotid artery with distal occlusion.

Technique: Diagnostic 5French catheter injection of 30ml of Isovue 300 at 25cc/sec.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Aortic arch angiography shows occlusion of the innominate artery and retrograde flow within the right vertebral artery and delayed retrograde distal innominate artery flow and subsequent anti-grade flow into the right common carotid artery and internal carotid artery with distal occlusion.

Technique: Diagnostic 5French catheter injection of 30ml of Isovue 300 at 25cc/sec.

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: DSA of the right internal carotid artery with complete resolution of the carotid-T and right middle cerebral artery occlusion.

Technique: 054 Reperfusion Catheter (Penumbra Inc., Alameda, CA) catheter injection of 4ml of Isovue 300 at 4cc/sec for right internal carotid artery digital subtraction angiography (DSA).

Click A 51-year-old male presented with acute transient left sided weakness. Chronic innominate artery steno-occlusive disease was identified by initial CT angiography without intracranial thromboembolic occlusion. Early recurrence and worsening of left sided weakness prompted a catheter based angiographic study, identifying hyperacute thromboembolic occlusion at the right carotid terminus. This was retrieved using combined local thromboaspiration and mechanical thombectomy preceded by innominate artery angioplasty.

Findings: Aortic arch angiography in the left anterior oblique projection demonstrates residual stenosis at the innominate artery and revascularization of the right carotid and right anterior circulation with symmetric flow relative to the contra-lateral side.

Technique: Diagnostic 5 French catheter injection of 30ml of Isovue 300 at 25cc/sec for aortic arch digital subtraction angiography.