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Angiographic string sign

The angiographic string sign, also known as the carotid string sign, refers to the thin string of intravenous contrast material distal to a stenotic focus in the internal carotid artery (ICA). 

Mechanism

A thin stripe of flow is caused by decreased pressure and flow distal to the stenosis, which causes collapse of the distal ICA.

Causes

An angiographic string sign may be caused by

  • preocclusive atherosclerosis at the carotid bifurcation
  • ICA dissection
  • ICA thrombosis
    • subacute partial
    • chronic sub total
  • partial recanalization of an occluded ICA
  • stenosis secondary to radiation

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