Abstract
We investigated the perioperative complications, clinical course, and outcomes of four consecutive patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass for symptomatic internal carotid artery (IC) occlusion with a contralateral severe stenotic or occlusive IC lesion. All patients experienced neurological deterioration in the perioperative period. Perioperative cerebral infarction occurred in three patients. Among these patients, two developed cerebral infarction in the territory of the anterior cerebral artery. It was considered that so-called “watershed shift” hemodynamic phenomenon was involved. Moreover, due to severe cerebrovascular insufficiency, postoperative hyperperfusion occurred in two patients. Prognostic evaluation just before the surgery compared with that at 3 months after the surgery showed improvement in one patient, no change in another, and worsening in two. None of the patients developed recurrent stroke during the follow-up period. Outcomes were regarded as unsatisfactory due to frequent perioperative complications, although most of the neurological deteriorations were transient. In patients undergoing STA-MCA bypass for symptomatic IC occlusion with a contralateral severe stenotic or occlusive IC lesion, a better understanding of the pathogenesis of perioperative cerebral infarction and postoperative hyperperfusion might promote the development of measures to improve patient outcomes.
