case_images: PMC11361982_01
case_images: Preoperative MRI brain without contrast, DWI (A) and ADC (B) sequences, demonstrating acute ischemia involving the left frontal lobe at the ACA-MCA border zone.
case_images: fsurg-11-1409692-g001.jpg
case_images: PMC11361982_01_fsurg-11-1409692-g001.jpg
case_images: F1
case_images: ACA-MCA border zone, involving the left paramedian frontal lobe, left periatrial white matter, and lateral right frontal lobe (Figure 1).
case_images: Preoperative DSA of the right ICA, anteroposterior (AP) (A) and lateral (B) views, early arterial phase, demonstrating occlusion of the right distal intracranial ICA distal to the pCoA, and AP (C) and lateral (D) views, late arterial phase, demonstrating leptomeningeal collateralization. DSA of the right VA, AP (E) and lateral (F) views, late arterial phase, demonstrating collateralization to the MCA and ACA territories. DSA of the left ICA, AP (G) and lateral (H) views, early arterial phase, demonstrating moderate stenosis of the distal ICA and proximal MCA and ACA with lenticulostriate collateralization.
case_images: fsurg-11-1409692-g002.jpg
case_images: PMC11361982_01_fsurg-11-1409692-g002.jpg
case_images: F2
case_images: CTA of the head and neck and subsequent catheter-based cervicocerebral DSA demonstrated occlusion of the right intracranial ICA just distal to the posterior communicating artery (PCoA) with collateralization to the right MCA and ACA territories through posterior circulation collaterals, consistent with Suzuki stage 6, as well as stenosis of the left distal intracranial ICA distal to the PCoA, and left proximal MCA and ACA (Figure 2), consistent with Suzuki stage 3.
case_images: Postoperative MRI brain without contrast, DWI (A) and ADC (B) sequences, demonstrating acute ischemia involving the bilateral ACA and MCA territories.
case_images: fsurg-11-1409692-g003.jpg
case_images: PMC11361982_01_fsurg-11-1409692-g003.jpg
case_images: F3
case_images: MRI brain without contrast demonstrated new acute infarcts involving the bilateral ACA and MCA territories (Figure 3).
case_images: Postoperative DSA of the left ICA, AP (A) and lateral (B) views, demonstrating occlusion of the left distal intracranial ICA distal to the pCoA.
case_images: fsurg-11-1409692-g004.jpg
case_images: PMC11361982_01_fsurg-11-1409692-g004.jpg
case_images: F4
case_images: CTA head and neck and subsequent catheter-based cervicocerebral DSA demonstrated occlusion of the left distal intracranial ICA distal to the PCoA with collateralization to the left MCA and ACA territories through posterior circulation collaterals (Figure 4), consistent with rapid progression to Suzuki stage 6 within 6 weeks of initial diagnosis.