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Revascularization for symptomatic occlusion of the anterior cerebral artery using superficial temporal artery.

Lee SC, Ahn JH, Kang HS, Kim JE - J Korean Neurosurg Soc (2013)

Bottom Line: 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.A 69-year-old man presented with several episodes of transient weakness involving left lower extremity.Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: Oral anticoagulant and antiplatelet agent were discontinued 1 week prior to surgery. After 2 months from experience of cerebral infarct, revascularization surgery was performed. After confirmation of sufficient length and integrity of parietal branch of the STA in preoperative ECA angiography, we planned end-to-side anastomosis between ipsilateral STA and distal ACA. Under general anesthesia, curvelinear skin incision was made along the parietal branch of the superficial temporal artery (STA), and then extended to the contralateral frontal just behind the hairline. The parietal branch of the STA were saved and prepared for anastomosis to the distal ACA. The frontal branch of the STA with galeal flap was saved as well during the preparation in case of adverse events, such as graft failure (Fig. 2). The length of parietal branch of the STA was 11 cm from the bifurcation of the STA. After right paramedian craniotomy and opening of the dura, the cortical branches of the right ACA were observed. We chose one of the cortical branches as a recipient artery, in which no flow was detected on the intraoperative Doppler. After confirmation of sufficient length and good pulsation of the parietal branch of the STA, end-to-side anastomosis between STA and ACA was performed (Fig. 2). Anterograde flow from the STA and flow diversion to the recipient artery was confirmed on the intraoperative Doppler.


Revascularization for symptomatic occlusion of the anterior cerebral artery using superficial temporal artery.

Lee SC, Ahn JH, Kang HS, Kim JE - J Korean Neurosurg Soc (2013)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921280&req=5

Figure 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.
Mentions: Oral anticoagulant and antiplatelet agent were discontinued 1 week prior to surgery. After 2 months from experience of cerebral infarct, revascularization surgery was performed. After confirmation of sufficient length and integrity of parietal branch of the STA in preoperative ECA angiography, we planned end-to-side anastomosis between ipsilateral STA and distal ACA. Under general anesthesia, curvelinear skin incision was made along the parietal branch of the superficial temporal artery (STA), and then extended to the contralateral frontal just behind the hairline. The parietal branch of the STA were saved and prepared for anastomosis to the distal ACA. The frontal branch of the STA with galeal flap was saved as well during the preparation in case of adverse events, such as graft failure (Fig. 2). The length of parietal branch of the STA was 11 cm from the bifurcation of the STA. After right paramedian craniotomy and opening of the dura, the cortical branches of the right ACA were observed. We chose one of the cortical branches as a recipient artery, in which no flow was detected on the intraoperative Doppler. After confirmation of sufficient length and good pulsation of the parietal branch of the STA, end-to-side anastomosis between STA and ACA was performed (Fig. 2). Anterograde flow from the STA and flow diversion to the recipient artery was confirmed on the intraoperative Doppler.

Bottom Line: 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.A 69-year-old man presented with several episodes of transient weakness involving left lower extremity.Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus