No contrast opacification of the proximal innominate artery measuring approximately 2.7 cm in length. Reconstitution of flow distally just prior to the bifurcation into the subclavian and right common carotid artery. There is delayed enhancement of these arterial vessels, likely related to a combination of high-grade stenosis/occlusion and retrograde flow through collateral vessels secondary to steal phenomenon.
High-grade stenosis of left common carotid artery is estimated at 65-70%. Atherosclerotic stenosis involving the left subclavian artery just proximal to the vertebral artery origin is estimated at approximately 90%.
Dense atherosclerotic calcification of the carotid bulbs and bifurcations bilaterally with estimated stenosis measuring 65-70% on the right and approximately 60% on the left.
Delayed contrast enhancement of the diminutive right vertebral artery with dense atherosclerotic calcification at its origin likely related to reversal of flow due to steal phenomenon.
Bulky plaque narrowing the origin of the left vertebral artery.