Fig. 2

The second procedure. a-b On Sep 9, 2020, emergent head NCCT showed no new lesion in the left hemisphere, and head CTP revealed a new core infarct of 18.2 mL in the left frontal lobe with an ischemic penumbral area of 100.4 mL in the left ICA supply area. c-i On Sep 9, 2020, an emergent EVT was performed. Preprocedural angiogram showed that the right ICA remained patent with residual moderate-to-severe stenosis and dissecting aneurysm and compensation to the left ACA and MCA via the ACom A (c), the left ICA was occluded distal to the bulb and manifested a flame sign with a refluxed flow to the C4 segment via the ophthalmic artery in the distal end (d); the position of the microcatheter tip (e. white arrow), the position of the CAT6 tip (e. black arrow), the position of the 8F guide catheter tip (e. red arrow); Applying with SCP technique, the left ICA was revascularized with a residual dissecting aneurysm (f. white arrow) and a red arrow indicated the key flow-limiting stenosis (f); red arrows indicated the distal and proximal markers of the 6 × 30 mm Solitaire FR stent (g); the P-A and oblique angiogram after stent detachment showed that the stenosis was relieved and the dissecting aneurysm disappeared (h-i). j-k On Sep 14, 2020, repeated head NCCT showed that the new core infarct appeared in the left frontal lobe, and head CTP suggested that the perfusion of bilateral ICAs blood supply areas returned to normal