Presentation
TIAs
Patient Data
Near complete obliteration of contrast opacification within the carotid canal. No supraclinoid portion visible. Poor opacification of the right M1 which is presumably filling from leptomeningeal collaterals. Marked paucity of M3 and distal MCA branches along the convexity.
Near complete obliteration of contrast opacification within the carotid canal. Distal supraclinoid ICA reconstitution via the left P-comm gives rise to a dominant left anterior cerebral artery and normal caliber middle cerebral artery. Hypoplastic right vertebral artery. Dominant left vertebral artery. Normal caliber basilar artery. A prominent left posterior communicating artery supplies retrograde flow to the supraclinoid left internal carotid artery.
Conclusion: The imaging findings are most likely in keeping with a Moya-Moya type phenomenon.
Bilateral supraclinoid ICA severe stenosis, likely occlusive. Multiple segmental irregularities, and narrowing along the petrosal and cavernous segments on the right and left respectively. Cervical ICAs are of very small caliber. MCAs opacifying via PCOMs on vertebral injections.