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Multiple stenotic regions in the anterior circulation, mainly central vessels (M1, A1 segments).
Enlarged perforator branches from left MCA giving rise to small corkscrew parenchymal vessels. This appearance of puff of smoke classical of moyamoya phenomenon.
Enlarged pericallosal and anterior choroidal arteries, again with collaterals.
Vertebrobasilar circulation (not shown) is not stenotic and is supplying collaterals to the anterior circulation, well rostral to the occipitoparietal sulcus. Similarly, the external carotid artery is fully patent and contributing to the anterior circulation.
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