Figure 1

Hard lesion in a patient with dissection in atherosclerosis (DA). A 54-year-old man was a heavy smoker and had a history of neck massage. He suffered from stroke with right hemiparesis in the past 1 year and had recurrent acute diplopia and dysarthria 1 month ago. Left vertebral angiogram showed a 90% stenotic lesion of the left distal vertebral artery (a, arrowhead) and disrupted intimal flaps (a, arrow). VW-MRI showed low signal intensity on fat-suppressed T1WI (b, arrow) and T2WI (c, arrow) and strong enhancement on contrast-enhanced fat-suppressed T1WI (d, arrow). PTAS was done and revealed a predilatation pressure (PP) of 6.5 atm. A 4 × 20 mm Wingspan stent was deployed in the left distal vertebral artery to basilar artery (e). About 30% residual stenosis was noted on the control angiogram (e, arrow). A 2-year follow-up CTA, curved multi-planar reconstruction, revealed 90% in-stent restenosis (f, arrow) and 30% residual stenosis of the proximal stent (f, arrowhead).