J Korean Neurosurg Soc.  2012 Dec;52(6):551-554. 10.3340/jkns.2012.52.6.551.

Superficial Temporal Artery-Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion by Subacute In-Stent Thrombosis after Carotid Artery Stenting

• Choi HJ
• Kim ST
• Jeong YG
• Jeong HW

• KMID: 1426266
• DOI: http://doi.org/10.3340/jkns.2012.52.6.551

Abstract

Alternative to carotid endarterectomy, carotid artery stenting (CAS) can be performed for symptomatic severe stenosis of internal carotid artery, especially for high-risk patients. Among several complications after CAS, subacute in-stent thrombosis is rare but important, because patient's condition can deteriorate rapidly. Subacute in-stent thrombosis with carotid artery occlusion can be managed by superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. We report two cases of STA-MCA anastomosis for internal carotid artery occlusion by subacute in-stent thrombosis after CAS.

Keyword

Carotid artery stenting (CAS); Subacute in-stent thrombosis; Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis

MeSH Terms

Carotid Arteries
Carotid Artery, Internal
Cerebral Arteries
Constriction, Pathologic
Endarterectomy, Carotid
Humans
Stents
Thrombosis

Figure

• 

  Fig. 1 A : Brain magnetic resonance imaging (MRI) shows small brain stem infarction on diffusion weighted image. B : Cerebral angiography reveals severe stenosis (83%) at right proximal internal carotid artery (ICA). C : Right carotid artery stenting and balloon angioplasty is being performed. D : In cerebral angiography, right proximal ICA occlusion is seen. E : In brain MRI, hemodynamic cerebral infarction is noted on diffusion image. F : Perfusion CT, diffusion-perfusion mismatch is seen. G : post-operation 7 days, follow-up computed tomography (CT) angiography and perfusion CT reveals maintenance of bypass flow and improvement of perfusion.

• 

  Fig. 2 A : In cerebral angiography, left proximal internal carotid artery (ICA) stenosis (72%) is aggravated. B : Left carotid artery stenting (CAS) and balloon angioplasty are done. C : Left proximal ICA occlusion is observed in neck angio CT (arrow). D : In brain MRI, hemodynamic cerebral infarction is noted on diffusion image.(Hemodynamic cerebral infarction is observed on diffusion view of brain MRI). E : After intravenous tissue plasminogen activator, angiographic revascularization of left ICA territory is confirmed through intra-arterial thrombolysis. F : Neck angio CT is performed since the patient's symptoms are not improved even after the intra-arterial and left proximal ICA occlusion is identified again (arrow). G : Diffusion-perfusion mismatch is seen on pre-operation perfusion CT image. Follow-up angio CT after the operation shows well-maintained bypass flow. H : Post-operation seven days, follow-up perfusion CT reveals improvement of cerebral blood flow.

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