A Case of Pediatric Idiopathic Intracranial Carotid Artery Dissection Successfully treated with Acute Superficial Temporal Artery-Middle Cerebral Artery (STA-MCA) Bypass

Abstract

  Intracranial cerebral artery dissection is a rare cause of pediatric occlusive cerebrovascular disease with no widely accepted medical or surgical treatment. In this report, we describe a case of a spontaneous intracranial carotid artery dissection in a 14-year-old boy presenting with right hemiparesis. Despite maximal medical treatment, the patient's neurological symptoms showed progressive worsening during the first 2 days after onset with a concurrent increase in left cerebral hemisphere deep white matter ischemic lesions. Hemodynamic instability was considered the cause of stroke progression, and an emergent revascularization surgery (superficial temporal artery-middle cerebral artery [STA-MCA] bypass) was performed. This resulted in improvement of the neurological symptoms and a good clinical outcome. Acute STA-MCA bypass may be an effective treatment option in select pediatric patients with intracranial carotid artery dissection whose symptoms progress regardless of maximal medical treatment.