Surgical Revascularization During the Acute Phase of Stroke Caused by Near Occlusion of the Cervical Internal Carotid Artery

An 83-year-old woman was admitted with a diagnosis of transient symptoms with a left hemisphere infarction due to atherosclerosis. Despite the best medical treatments, her neurological symptoms gradually deteriorated. The color Doppler ultrasound (CDUS) and digital subtraction angiography (DSA) demonstrated a near occlusion of the left cervical internal carotid artery. Because the intracranial internal carotid artery (ICA) seemed patent on DSA, although CDUS also suggested that the intracranial ICA was also occluded, carotid endarterectomy was performed. However, magnetic resonance angiography performed immediately after the operation showed distal occlusion of the ICA. A superficial temporal artery-middle cerebral artery (MCA) bypass was performed immediately to rescue the region that was perfused by the MCA. The neurological symptoms stabilized after the operation. It is often difficult to assess the patency of the intracranial ICA by DSA if distal ICA flow is slow and faint. Although the pulsed Doppler waveform can be affected by the site of the distal occlusion, CDUS would be a good addition to the preoperative evaluation. And if the patency of the ICA distal to the stenosis cannot be confirmed, especially in emergent settings, a superficial temporal artery-MCA bypass can be a good treatment option.
Source: Neurosurgery Quarterly - Category: Neurosurgery Tags: Case Reports Source Type: research