case_images: PMC11809605_01
case_images: Carotid duplex ultrasound of left and right ICA showing filling defects and stenosis. ICA: internal carotid artery.
case_images: jmc-16-082-g001.jpg
case_images: PMC11809605_01_jmc-16-082-g001.jpg
case_images: F1
case_images: Carotid duplex ultrasound performed the day prior to his ED visit demonstrated 50-79% stenosis in the bilateral ICAs with broad-based filling defects and hyperechoic intraluminal components in the internal bulbs (Fig. 1).
case_images: Coronal, sagittal, and axial views highlighting the right common and external carotid artery segments appear normal. There is approximately 80% stenosis of the proximal right internal carotid artery (white arrow). There is hypo-enhancement of the distal right internal carotid artery (black arrow).
case_images: jmc-16-082-g002.jpg
case_images: PMC11809605_01_jmc-16-082-g002.jpg
case_images: F2
case_images: Head and neck computed tomography angiography (CTA) revealed 80% stenosis in the proximal right ICA and 65% stenosis in the left ICA, with no evidence of acute infarct or intracranial lesions (Fig. 2).
case_images: Intraoperative photo of excised section of right proximal internal carotid artery with the presence of a fibrous band protruding from the posterior lumen. Note the absence of an atheroma characteristic of atherosclerosis.
case_images: jmc-16-082-g003.jpg
case_images: PMC11809605_01_jmc-16-082-g003.jpg
case_images: F3
case_images: Intraoperatively, a web was identified in the proximal right ICA with some mild evidence of atherosclerotic plaque; lesion was circumferential, fibrotic, and near occlusive with a pine-hole like opening (Figs. 3 and 4).
case_images: Intraoperative photo highlighting the pin-hole opening rolled up and recreating natural intraluminal morphology (arrow).
case_images: jmc-16-082-g004.jpg
case_images: PMC11809605_01_jmc-16-082-g004.jpg
case_images: F4
case_images: Intraoperatively, a web was identified in the proximal right ICA with some mild evidence of atherosclerotic plaque; lesion was circumferential, fibrotic, and near occlusive with a pine-hole like opening (Figs. 3 and 4).