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Internal carotid artery occlusion and vault moyamoya (angiography)

Angiography in a 57-year-old woman with left middle cerebral artery infarction and hemorrhagic transformation. (A) Right internal carotid artery (ICA) injection, lateral view. The supraclinoid right ICA is occluded. Right middle cerebral artery branches reconstitute via prominent moyamoya vessels in the basal ganglia (black arrow). The right ophthalmic artery is enlarged; several moyamoya vessels arise from the anterior ethmoidal artery (white arrow). (B) Right external carotid artery, AP view. Vault moyamoya. There is early reconstitution of the right anterior cerebral artery territory from the right middle meningeal artery. (Contributed by Dr. Jose Biller.)