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A 67 year old woman with a thrombosed aortic arch aneurysm, presented with numbness in her left arm and a substantial decrease in blood pressure (122/94 mm Hg), which compared unfavourably with the blood pressure of her right arm (156/90 mm Hg). A conventional angiogram revealed a prominent stenosis in the left subclavian artery, more proximal than the site of the juncture with the vertebral artery. Percutaneous transluminal angioplasty was performed, a stent was successfully implanted, and the discrepancy in blood pressure was resolved (left arm 146/92 mm Hg, right arm 150/90 mm Hg). Enhanced multislice computed tomography (MSCT) (Light Speed Ultra 16, General Electric, Milwaukee, USA) was performed (slice thickness 0.625 mm; helical pitch 3.25), using the following technique. The patient was given an intravenous injection of 100 ml of iodinated contrast medium (350 mgI/ml) and MSCT scanning was carried out after a 30 second delay. Volume data were extracted at the end of diastole and transferred to a workstation (Virtual Place Office Azemoto, Tokyo, Japan). Three dimensional, contrast enhanced, volume rendered images were reconstructed through retrospective ECG gating.
A multiplanar, reconstructed image clearly showed the patent lumen of the proximal portion of the left subclavian artery, surrounded by the implanted stent graft (panel above). Volume rendered images revealed the implanted stent graft on the proximal portion of the left subclavian artery, and displayed the spatial relationship of the graft to the vertebral artery and other branches of the aortic arch, such as the left common carotid artery (CCA) (right upper and lower panels). Furthermore, the volume rendered images allowed the thrombosed aneurysm to be easily visualised (right upper panel).