Intracranial Atherosclerosis : Figure 1

Dramatically increased cerebral blood flow following stent supported angioplasty in a 77-year-old man with worsening dizziness, double vision, and difficulty speaking clearly, all signs and symptoms of vertebrobasilar insufficiency, a form of inadequate brain blood flow despite heparin anticoagulation and the use of antiplatelet agents. A, arteriogram, demonstrating pre-occlusive (>90%) narrowing of the right vertebrobasilar junction (arrow). The left vertebral artery had already occluded in the neck, but it was reconstituted by retrograde filling from the vertebrobasilar junction. B, arteriogram, after stenting ( arrows), showing that the artery is widely patent. C, xenon-enhanced CT scan, before treatment, demonstrating reduced cerebral blood flow of 28 to 30 ml/100 g tissue per minute. D, 36-hour post-treatment xenon-enhanced CT scan, showing quantitatively elevated perfusion of the posterior circulation with relative cerebral blood flow of 61 to 66 ml/100 g tissue per minute.