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(Circulation. 2006;114:e499-e500.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Angiographic Computed Tomography for Imaging of Underdeployed Intracranial Stent

Goetz Benndorf, MD, PhD; Richard P. Klucznik, MD; Charles M. Strother, MD

From the Methodist Hospital Research Institute (G.B.), Department of Radiology (G.B., R.P.K., C.M.S.), The Methodist Hospital, Houston, Tex.

Correspondence to Goetz Benndorf, MD, PhD, Department of Radiology, The Methodist Hospital, 6565 Fannin, Houston, TX 77030. E-mail gbenndorf@tmh.tmc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 77-year-old woman presented with a transient ischemic attack. Cerebral angiography showed occlusion of the supraclinoid segment of the right internal carotid artery, a persistent trigeminal artery, and an 80% stenosis of the cavernous segment of the internal carotid artery. After deployment of a 3 mm x13 mm, balloon-expandable stent (Bx SONIC, Cordis, Miami Lakes, Fla), a control angiogram demonstrated a residual stenosis, which remained even after repeated balloon inflation. An underlying calcification was assumed. (Figure, A). Although the patient had remained asymptomatic since initial treatment, the angiographic follow-up after 6 months showed a significant in-stent restenosis (Figure, B). Nonsubtracted images could not provide sufficient diagnostic information about the stent itself because of sphenoid osseous structures adjacent and surrounding the cavernous carotid artery (Figure, C and D).

View larger version (112K): [in this window] [in a new window]   A and B, Right internal carotid artery injection, later view immediately after stenting shows a residual stenosis of the cavernous segment (A, arrow). A follow-up angiogram 6 months later shows the development of in-stent restenosis (B, double arrow). Note also the occlusion of the supraclinoid segment (short arrow) and the prominent persistent trigeminal artery supplying the posterior circulation (arrowheads). C and D, Nonsubtracted images lateral and anteroposterior (B) view shows the stent (dashed arrows) insufficiently because of overlying osseous structures in the parasellar region. E and F, Maximum intensity projections in 5-mm sections (angiographic computed tomogram) revealing not only the effective narrowing of the stent but also its cause: Heavily calcified circumferential plaque (white arrowheads). G . . . [Full Text of this Article]

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