Superficial Temporal Artery Middle Cerebral Artery Anastomosis for Patient with Near Occlusion of the Internal Carotid Artery

Abstract

We experienced STA-MCA anastomoses with 4 symptomatic patients with near occlusion of the internal carotid artery (ICA) who demonstrated hemodynamic ischemia confirmed by cerebral blood flow (CBF) measurement. Although we had usually performed carotid endarterectomy (CEA) for patients with near occlusion of the ICA, we performed STA-MCA anastomosis for these patients. The reasons for performing STA-MCA anastomoses were difficulties of CEA due to highly positioned stenosis and high risk of hyperperfusion after CEA because of preoperative hemodynamic ischemia. There were no perioperative complications or restrokes during follow-up (from 6 months to 5 years and 1 month).
Evaluation of the CBF of these patients after CEA showed improvement in both resting CBF and cerebral vascular reactivity.
Therefore, STA-MCA anastomosis may be effective for the patient with near occlusion of the internal carotid artery (ICA) who has a high risk of CEA and hemodynamic ischemia.