Superficial Temporal Artery-Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion by Subacute In-Stent Thrombosis after Carotid Artery Stenting
A 69-year-old male patient visited the emergency department due to dysarthria and left extremity weakness. The National Institutes of Health Stroke Scale (NIHSS) score was 3 points. Brain MRI showed small brain stem infarction on diffusion weighted image (). Cerebral angiography revealed severe stenosis (83% in diameter stenosis) at right proximal ICA (). Right CAS and balloon angioplasty were performed and there were no perioperative problems (). The patient was discharged with dual antiplatelet medication therapy. However, nine days after CAS, the patient revisited the emergency department because of hemiparesis, dysarthria, and left facial palsy. The patient stated that the symptoms had been gradually aggravated since three days prior to the visit. NIHSS score was 8 points. In cerebral angiography, right proximal ICA occlusion was identified (). In brain MRI, hemodynamic cerebral infarction was noted on diffusion image and diffusion-perfusion mismatch was seen on perfusion image (). Thirteen days after the occurrence of right proximal ICA occlusion, STA-MCA anastomosis was performed. His symptoms were improved (), but left hemiparesis and dysarthria were remained. Three months after surgery, his mRS score was 3 points.