J Cerebrovasc Endovasc Neurosurg.  2018 Jun;20(2):127-132. 10.7461/jcen.2018.20.2.127.

Revision Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery for Recurrent Acute Ischemic Stroke Due to Delayed Occlusion of the Bypass Graft

• Choi YH
• Park HS
• Kang MJ
• Cha JK

• KMID: 2422607
• DOI: http://doi.org/10.7461/jcen.2018.20.2.127

Abstract

Intravenous thrombolysis (IVT) and endovascular treatment (EVT) are currently the main treatments for reperfusion in acute ischemic stroke. Although the EVT recanalization rate has increased, unsuccessful recanalization is still observed in 10-30% cases. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is considered a rescue therapy in such cases, but in most centers it is not usually performed for acute ischemic stroke. Graft occlusion is rare following STA-MCA bypass, but it might lead to recurrent ischemic stroke. We hereby report on a patient with right MCA infarction and in whom EVT failed due to complete proximal internal carotid artery occlusion. He underwent an emergency STA-MCA bypass, resulting in a full recovery of his motor weakness. However, six months later, the patient experienced recurrent acute ischemic stroke due to bypass graft occlusion. His EVT failed again but revision bypass surgery, using STA remnant branch, was successful with full motor weakness recovery. We recommend a revision bypass surgery as a feasible therapeutic option for recurrent cerebral infarction caused by delayed STA graft occlusion.

Keyword

Stroke; Cerebral revascularization; Vascular graft occlusion; Reoperation

MeSH Terms

Carotid Artery, Internal
Cerebral Arteries*
Cerebral Infarction
Cerebral Revascularization
Emergencies
Graft Occlusion, Vascular
Humans
Infarction, Middle Cerebral Artery
Reoperation
Reperfusion
Stroke*
Transplants*

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