CT ANGIOGRAM HEAD AND NECK WITH CONTRAST — Radiology report (direct)
Result date: 8/22/2026 · Kaiser · Marked HIGH PRIORITY / ACTION REQUIRED in referring provider inbox

** HISTORY **: 68 years old, Stroke/TIA, assess intracranial arteries
** TECHNIQUE **: 94 mL Omnipaque 350 IV contrast. MIP vessel images. CTDI: 0.07,0.55,42.57,24.75 mGy. DLP: 2.99,23.92,21.28,989.87 mGy-cm
** COMPARISON **: CTs 8/21/2026, 7/18/2026, MRs 7/16/2026, 10/30/2025

IMPRESSION:
1. Occluded right common carotid artery at the origin with reconstitution of the right distal common carotid artery with extensive atherosclerotic calcifications in the right common carotid artery, right carotid bulb and proximal right internal carotid artery and proximal right external carotid artery with approximately 80% stenosis in the proximal right internal carotid artery.
2. Approximately 76% stenosis in the proximal left internal carotid artery.
3. Multifocal intracranial stenosis with moderate bilateral paraclinoid and right supraclinoid internal carotid artery narrowing, mild to moderate left P1/P2 narrowing and mild right P1/P2 narrowing and diffuse irregularity and mild narrowing of the right M1 and mild narrowing in the left distal M1.
4. Mild bilateral intracranial vertebral artery stenosis.

FINDINGS:
CTA HEAD: Multifocal intracranial stenosis as above. Recent right temporal occipital lobe infarcts and right thalamus infarcts and chronic left frontal lobe infarcts are again noted.
CTA NECK GREAT VESSELS: Right common carotid artery is occluded at the origin.
RIGHT ICA: R CCA occluded at origin; mild fluid noted in right distal CCA; extensive atherosclerotic calcifications. ~80% stenosis (NASCET, series 601 image 21) at carotid bifurcation.
LEFT ICA: ~76% stenosis (NASCET, series 2 image 125) at carotid bifurcation; extensive calcified plaque. No dissection.
VERTEBRAL ARTERIES: Patent extracranial segments. No dissection.
OTHER: Diffuse emphysematous changes with bulla. Calcified left hilar granulomas. Mild degenerative changes.

KEY TAKEAWAYS
- Severe bilateral carotid disease: R CCA occluded at origin (chronic, with reconstitution), ~80% R ICA stenosis, ~76% L ICA stenosis
- Multifocal intracranial stenosis (moderate paraclinoid/supraclinoid ICAs, mild-moderate left P1/P2, mild right M1/left distal M1, mild bilateral vertebral)
- Recent stroke territory confirmed: right temporal-occipital + right thalamus (R PCA — posterior circulation, NOT carotid territory)
- Chronic left frontal lobe infarcts (old strokes — likely signature of the left carotid disease)
- Incidental: emphysema with bulla (COPD on imaging), calcified left hilar granulomas
- No dissection. No acute findings on 8/21 CT head.
- Flag: ACTION REQUIRED → vascular surgery e-consult (placed by ED 8/22) is the active item
