Figure 3

Distal atherosclerotic plaques causing long-segment occlusion of the internal carotid artery (ICA) treated with hybrid surgery in a patient in their 40 s with dizziness and left limb weakness. (A) Magnetic resonance imaging (MRI) showed multiple acute infarction lesions in the right hemisphere. (B–E) The time-to-peak (B) and mean transit time (C) were prolonged, and the cerebral blood volume (D) and cerebral blood flow (E) were decreased. (F) Computed tomography angiography revealed occlusion of the right ICA. (G) Digital subtraction angiography demonstrated occlusion of the right ICA. (H,I) Arteriotomy of the right ICA was performed for use of a Forgarty balloon to remove the atherosclerotic plaque (H), and the thrombus was approximately 7 cm long (I). (J,K) After plaque removal and recanalization of the ICA, a stenosis of the ICA ophthalmic segment was treated with balloon dilation, and smooth blood flow was resumed in the right ICA even though a slight stenosis remained at the ICA ophthalmic segment.