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A 63-year-old woman was referred for evaluation of a transient ischemic attack with right arm and leg involvement. On examination, she had a right neck bruit. The head CT scan showed a small, old ischemic infarction in the periventricular area of the right frontal lobe. Digital substraction angiography revealed a total occlusion of both internal carotid arteries, a severe stenosis of the origin of the right vertebral artery ( Figure , upper left), and an atretic left vertebral artery. The rightdoi:10.1161/01.cir.103.11.e61 pmid:11257093 fatcat:oly3jgvhmjhtlom5tf3xchjz3u