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J Cerebrovasc Endovasc Neurosurg. 2018 20(3): 191-197
The Journal of Cerebrovascular and Endovascular Neurosurgery
STA-Distal ACA Bypass Using a Contralateral STA Interposition Graft for Symptomatic ACA Stenosis
Yoon Ha Hwang1, Young Sub Kwon2, Yun Ho Lee2
1Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, 2Department of Neurosurgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous- supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.
Key words : Anterior cerebral artery, Cerebral revascularization, Infarction, Temporal arteries

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