J Korean Neurosurg Soc.  2013 Dec;54(6):511-514. 10.3340/jkns.2013.54.6.511.

Revascularization for Symptomatic Occlusion of the Anterior Cerebral Artery Using Superficial Temporal Artery

• Lee SC
• Ahn JH
• Kang HS
• Kim JE

• KMID: 2190948
• DOI: http://doi.org/10.3340/jkns.2013.54.6.511

Abstract

Isolated symptomatic occlusion of the anterior cerebral artery (ACA) is a rare condition and until date, only few cases regarding the revascularization of the ACA have been reported. This paper reports on successful attempt to revascularize the ACA using superficial temporal artery (STA) in patient with isolated symptomatic occlusion of the ACA. A 69-year-old man presented with several episodes of transient weakness involving left lower extremity. Cerebral angiography showed occlusion of the right ACA at the A2 segment. After medical treatment failure, the patient underwent STA-ACA bypass surgery. Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory. Bypass surgery can be considered in the patients with symptomatic occlusion of the ACA, who have experienced failure in medical treatment.

Keyword

Anterior cerebral artery; Superficial temporal artery; Occlusion; Bypass

MeSH Terms

Aged
Angiography
Anterior Cerebral Artery*
Cerebral Angiography
Follow-Up Studies
Humans
Ischemic Attack, Transient
Lower Extremity
Temporal Arteries*
Treatment Failure

Figure

• 

  Fig. 1 Initial MRI, cerebral angiography, and SPECT of a 69-year-old man. MRI shows acute infarct in the right frontal periventricular white matter (A). Cerebral angiography reveals occlusion of right ACA at the A2 segment with insufficient filling of the right ACA territory (B), and minimal collateral flow from right PCA (C). Basal and acetazolamide-stressed SPECT shows decreased perfusion (D) and vascular reserve (E) in right frontal lobe. SPECT : single photon emission computerized tomography, ACA : anterior cerebral artery, PCA : posterior cerebral artery.

• 

  Fig. 2 Intraoperative photograph illustrating the preparation of the right STA (arrow) (A), and anastomosis between cortical branch of the ACA and parietal branch of the STA (B). ACA : anterior cerebral artery, STA : superficial temporal artery.

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  Fig. 3 Cerebral angiography and brain SPECT obtained on the sixth postoperative months. Cerebral angiography reveals anterograde flow through right STA to the territory of the right ACA (A : anteroposterior view, B : oblique view) and decreased leptomeningeal collateral flow from right PCA (C). Basal and acetazolamide-stressed SPECT shows improved perfusion (D) and vascular reserve (E) upon comparison with preoperative imaging. SPECT : single photon emission computerized tomography, STA : superficial temporal artery, ACA : anterior cerebral artery, PCA : posterior cerebral artery.

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