Intracranial Atherosclerotic Disease (ICAD): Submaximal Angioplasty
A 58-year-old male with past medical history of DM, HTN, and hyperlipidemia on treatment presented with left eye visual obscurations since morning, was initially seen by an ophthalmologist, and was cleared of ocular pathology. Later in the day, he had confusion and difficulty in reading newspapers. He came to the hospital by around 8 PM as his confusion progressed. MRA revealed non-visualization of left ICA beyond bifurcation (Fig. 89.1a), and half an hour later he developed a complete left MCA syndrome with NIHSS of 22. Intravenous tPA was administered, and patient was transferred to the neurointerventional suite. The DSA revealed no flow in the ICA just distal to bifurcation (Fig. 89.1c). There is good collateral across the Acom to the left ACA (Fig. 89.1b).
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