Surgical Treatment for Atherosclerotic Intracranial Arterial Stenosis

Abstract

Progressive worsening of atherosclerotic intracranial arterial stenosis is difficult to manage. When atherosclerotic plaques are severe and unstable, expansion using endovascular methods is unsafe. To restore hemodynamic insufficiency, placing a distal bypass without irritating the unstable plaques may be safer. We present seven cases of progressive atherosclerotic middle cerebral artery (MCA) stenosis treated with consecutive superficial temporal artery (STA)–MCA double-bypass. In all cases, mid- to long-term bypass patency without post-operative infarction was confirmed using MRA. Meticulous STA donor preparation and precise approximation of the intima of both donor and recipient during anastomosis are key.