Figure 16:
72-year-old male presented 3 hours following left carotid endarterectomy (CEA) with new onset right arm weakness. CEA had been performed for a severe but asymptomatic carotid artery stenosis, discovered during work-up for a carotid bruit.
(A) Curved reformatted view of the left carotid artery (arrow) shows a normal lumenal diameter following CEA, without evidence of dissection or restenosis.
(B) Maximum intensity projection view of the circle-of-Willis shows increased flow in the distal left MCA branches (arrows).
(C) Quantitative CTP images reveal marked increased CBV and CBF throughout the left hemisphere, with corresponding decrease in MTT. These findings were interpreted as consistent with reperfusion hyperemia to a chronically ischemic tissue bed. The patient was monitored carefully in the post-op intensive care unit, and the symptoms resolved over the next few hours.