Superficial Temporal Artery–Middle Cerebral Artery Bypass Surgeryfor Crescendo Transient Ischemic Attack Due to Intracranial Artery Stenosiswith a Contralateral Internal Carotid Artery Occlusion

Abstract

We report a case of enforced superficial temporal artery-middle cerebral artery (STA-MCA) bypass for ICA stenosis with a contralateral ICA occlusion associated with crescendo transient ischemic attack (TIA). A 52-year-oldman suffered from weakness of right lower limb. MRI showed cerebral infarction of the bilateral watershed areaat frontal lobe and right ICA occlusion. DSA and perfusion-weighted imaging using arterial spin labeling revealedright ICA occlusion, left ICA terminal stenosis, and hypoperfusion in the left side. Medical treatment with dualanti-platelet therapy and Edaravone was performed, however, lower limb motor weakness had been a frequentoccurrence. After STA-MCA bypass, the symptom disappeared. STA-MCA bypass for crescendo TIA due to intracranial artery stenosis with a contralateral internal carotid artery occlusion was effective.