To create a new stream you would use PDFDoc.CreateIndirectStream, and then on your annotation call something like annot.GetSDFObj().Put("IMAGE_A", objFromCreateIndirectStream)
Here are some guides that will help you the rest of the way.
To create a new stream you would use PDFDoc.CreateIndirectStream, and then on your annotation call something like annot.GetSDFObj().Put("IMAGE_A", objFromCreateIndirectStream)
Here are some guides that will help you the rest of the way.