A 41-year-old woman was referred to radiology department for the evaluation of sudden paresis in the left side. Brain magnetic resonance imaging (MRI) showed multiple bilateral ischemic regions in the watershed areas. Also, the brain magnetic resonance angiography (MRA) showed bilateral internal carotid artery (ICA) occlusions at the level of the cervical ICA region. Both vertebral arteries were found to be enlarged (arrow) and the retrograde filling of the anterior circulation was observed (Fig. A). For the investigation and the differentiation of the bilateral carotid lesions, the color Doppler ultrasonography was obtained. This study showed homogenous, hypoechoic, circumferential wall thickening of both distal common carotid artery arteries (CCA). The thickening of the arteries wall were like ‘Macaroni’. The wall thickness was 0.17 cm (Fig. B). The tapering of both CCA and total oclusion of both ICA were seen. The carotid MRA revealed collateral circulation from the subclavian arteries to the ECA and 50% stenosis of the left CCA (arrow) and 70% stenosis of the right CCA at its origin. Vertebral arteries were also prominant and there were 50% narrowing in the mid portion of the left subclavian artery (Fig. C). The radiological diagnosis of the Takayasu’s arteritis (TA) was made and the patient was referred to the rheumatology clinic for further diagnosis and work-up.