CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
DOI: 10.1055/s-0040-1721335
Original Article | Artigo Original

Superficial-Temporal-Artery-To-Middle-Cerebral-Artery Bypass in Cerebrovascular Occlusive Disease and Hemodynamic-Related Ischemia: Illustrative Case and Literature Review

Bypass STA-MCA para doença cerebrovascular oclusiva e isquemia hemodinâmica: Caso ilustrativo e revisão da literatura
Gustavo Rassier Isolan
1  Department of Neurosurgery, The Center for Advanced Neurology and Neurosurgery (CEANNE), Porto Alegre, Brazil
,
Ricardo de Andrade Caracante
2  Department of Neurological Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
João Paulo Mota Telles
2  Department of Neurological Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Nícollas Nunes Rabelo
2  Department of Neurological Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
,
Eberval Gadelha Figueredo
2  Department of Neurological Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
› Author Affiliations

Abstract

Stroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of the middle cerebral artery (MCA), with a history of ∼ 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs. We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.

Resumo

Acidentes vasculares cerebrais (AVC) são a terceira causa de mortalidade mundialmente. Entre 10 e 15% dos AVCs relacionados à artéria carótida estão associados com sua oclusão completa. Há um subgrupo importante de pacientes com doenças cerebrovasculares oclusivas que podem se beneficiar de um by-pass carótida-externa-carótida-interna. Neste estudo, reportamos o caso de um homem de 53 anos com estenose do ramo M2 da artéria cerebral média, com história de 20 acidentes isquêmicos transitórios (AIT), que foi tratado com anastomose de M4 com a artéria temporal superficial. O paciente foi de alta no terceiro dia pós-operatório e, em dois anos de follow-up, não houve mais AITs. Também conduzimos uma revisão da literatura sobre doença cerebrovascular oclusiva e by-pass intra-extracraniano. Novos métodos para avaliar a hemodinâmica cerebral tornaram possível a classificação de um novo subgrupo de pacientes com doença cerebrovascular sintomática em quem a terapia medicamentosa falhou, que podem se beneficiar de um by-pass intra-extracraniano. Nosso relato de caso ilustra as vantagens de revascularização em pacientes selecionados.



Publication History

Received: 22 July 2020

Accepted: 25 September 2020

Publication Date:
18 January 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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