Vascular disease in smoker. Angiogram of the supra-aortic trunks of a 64-year-old smoker with hypertension (high blood pressure), showing extensive vascular disease. Seen here are stenotic (narrowed) lesions at the opening (ostium) of the right brachiocephalic artery and right vertebral artery due to atherosclerosis, along with severe stenosis (narrowing) of the left internal carotid artery and hypoplasia (underdevelopment) of the left vertebral artery.