2022 Volume 50 Issue 6 Pages 503-507
We report a case of progressive cerebral infarction due to middle cerebral artery (MCA) stenosis treated with balloon percutaneous transluminal angioplasty (PTA), followed by superficial temporal artery -to-middle cerebral artery (STA-MCA) bypass.
An 82-year-old man was admitted to our hospital for sudden left hemiparesis. Magnetic resonance imaging (MRI) demonstrated severe stenosis in his right MCA and multiple cerebral infarctions in the corresponding region. In spite of our initial aggressive medical management, the patient presented with left hemispatial neglect on day five. MRI showed enlarged lesions. Accordingly, we conducted urgent balloon PTA in order to avoid aggravation. Although the MCA was dilated sufficiently, restenosis was a concern from a long-term perspective because the lesion was longer than 10 mm. Therefore, we added STA-MCA bypass subsequently on day 11. No further infarction was detected after both treatments. The patient was discharged after four months of rehabilitation. Computed tomography angiography (CTA) on day 90 showed restenosis of the MCA. These observations suggest that early STA-MCA bypass may have prevented stroke progression.
