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We appreciated the interest of Zhang and colleagues and reviewed the CTA images of the cervicocranial arteries from our patient with TIA. We confirm that the horizontal segment of the left MCA was occluded. Subtle high–attenuation density images between the site of the occlusion and the distal branches resulted from venous structures. Notably, CTA had been performed using a 16-slice multidetector scanner, and the intracranial arteries had been studied in the later part of the procedure. This is why the pictures show both arteries and veins, including both the superior ophthalmic veins in the source axial image. Though the most sensitive technique is intra-arterial catheter angiography, it was not indicated in the clinical setting.
Cerase A, Vallone IM, Tassi R, Bellini M, Martini G, Venturi C. Neuroimaging of Transient Ischemic Attack—Reply. Arch Neurol. 2010;67(12):1534-1535. doi:10.1001/archneurol.2010.306