Abstract
Background Human immunodeficiency virus (HIV) associated vasculopathy can cause ischemic cerebral
stroke; however, there is limited evidence on optimal management. Herein, we report
a case of acute ischemic stroke due to progressive internal carotid artery (ICA) stenosis
in an HIV-positive patient. Superficial temporal artery to middle cerebral artery
(STA-MCA) bypass, in addition to the best medical treatments, prevented stroke progression.
Clinical Description A 39-year-old man with HIV infection presented with a sudden onset of aphasia and
right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left
basal ganglia and concentric thickening of the vessel wall in the terminal portion
of the bilateral ICAs. Despite maximal medical treatments for HIV-associated vasculopathy
and possible opportunistic infections, bilateral ICA stenoses progressed, leading
to a second hemodynamic stroke event. Because tissue plasminogen activator treatment
failed, we performed STA-MCA bypass. A significant improvement in neurologic symptoms
and cerebral blood flow was observed after surgery. No further stroke events occurred
during the continuation of medical treatments.
Conclusion This is the first case of STA-MCA bypass performed in a patient with recurrent ischemic
stroke caused by HIV-associated vasculopathy. Although further evidence is needed,
such treatment options can shed new light on the management of progressive HIV-associated
vasculopathy, which is refractory to maximal medical treatment.
Keywords
acquired immunodeficiency syndrome - EC-IC bypass - STA-MCA bypass - vessel wall magnetic
resonance imaging
