A 56-year-old man with a 60-pack-year history of smoking suffered a right sided stroke three months prior to the present admission. Ultrasound showed evidence of occlusion of the right internal carotid artery. Subsequent magnetic resonance angiogram (MRA) was read as a focal 20 mm occlusion of the right internal carotid artery with probable distal reconstitution.
Angiogram performed prior to surgery showed 95% stenosis of the right internal carotid artery with a string sign. There was slow antegrade distal filling.
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