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. 2014 Feb 27;6(1):3. doi: 10.1186/2036-7902-6-3

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Copyright © 2014 Herzberg et al.; licensee Springer.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cross-filling suggestive of high-grade stenosis or occlusion of the ICA. Images obtained in a 73-year-old patient suffering from a TIA with a 5-min-long paresis of the right leg. During transport, the patient's high blood pressure and angina pectoris prompted a decision to admit him to the Department of Cardiology. The results of the TCCS changed that decision, however, and the patient was admitted to the Stroke Unit. Surgery was performed the following day. (a) TCCS reveals normal flow in the left MCA. (b) Flow in the left ACA was increased and retrograde, suggesting collateral filling through the anterior communicating artery. (c) CT-angiography shows patency of all intracranial arteries but lacks flow information. (d) DSA on the same day confirms a tight, high-grade stenosis at the origin of the left ICA.