症 例
内頚動脈閉塞に合併した前中大脳動脈領域血流不全に対する一期的血行再建を行った1例
キーワード:
anterior cerebral artery,
bypass,
carotid artery occlusion,
superficial temporal artery,
revascularization
2019 年 47 巻 4 号 p. 272-276
詳細
2019 年 47 巻 4 号 p. 272-276
Ischemic symptoms of the anterior cerebral artery (ACA) are rarely concomitant with internal carotid artery (ICA) occlusion. When the A1 segment of the ACA is hypoplastic or aplastic contralaterally, cerebral ischemic stroke in the territory of the ACA and middle cerebral artery (MCA) due to hemodynamic insufficiency may occur with ipsilateral ICA occlusion. Hemodynamic studies, such as single-photon emission computed tomography (SPECT), demonstrate that cerebral perfusion and vascular reserve greatly decreased on the ICA occlusive side in such patients. Treatment by surgical revascularization of the ACA and MCA territories is difficult, and few such cases have been reported.
We report a method for revascularizing the ACA and MCA ischemic territories using bilateral superficial temporal artery (STA). We reported the case of a patient who underwent ipsilateral STA-MCA double bypass and STA-bilateral ACA bypass simultaneously. Bilateral ACAs were revascularized using an interposed Y graft of the STA anterior branch connected to the posterior branch of the STA.
The patient gained good perfusion in the ACA and MCA territories after surgery and remained without symptoms, as detected on 1-year follow-up SPECT. We discuss the etiology and surgical treatment and review the literature on hemodynamic insufficiency in the ACA areas caused by ICA occlusion.
