Abstract
A 65-year-old female presented with right oculomotor nerve palsy due to a large internal carotid artery (ICA) cavernous aneurysm. She underwent ligation of the right ICA with an external carotid artery to middle cerebral artery high-flow bypass (HFB).
Although her postoperative course was uneventful, she developed a cerebral infarction at the right internal capsule 5 months after surgery.
Cerebral angiography revealed a filling defect at the origin of the anterior choroidal artery. We suspected that the blood current from HFB and the posterior communicating artery formed a “currentrip” at the C1 segment of the right ICA. Soon after introduction of antithrombotic therapy, her symptoms completely resolved.
Angiography 3 months after the stroke revealed no filling defect at that site.
This is the first report demonstrating the occurrence of ischemic stroke in the chronic phase of carotid ligation surgery with HFB. Hence, careful observation is required for these patients, even after discharge.
