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Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion.

Yamamoto S, Kashiwazaki D, Akioka N, Kuwayama N, Kuroda S - Surg Neurol Int (2015)

Bottom Line: His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma.Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery.His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.

ABSTRACT

Background: Common carotid artery (CCA) occlusion sometimes requires surgical revascularization to resolve persistent cerebral/ocular ischemia. High-flow bypass is often indicated in these cases, using the interposed graft such as saphenous vein and radial artery. However, high-flow bypass surgery is invasive and may provide excessive blood flow to ischemic brain. In this report, we present a case that developed neovascular glaucoma due to CCA occlusion and was successfully treated with superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis.

Case description: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the CCA was occluded. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Blood flow measurement showed an impaired reactivity to acetazolamide in the left cerebral hemisphere. Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery. Therefore, he successfully underwent left STA-MCA double anastomosis. His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

Conclusions: Precise radiological examination may enable standard STA-MCA anastomosis even in patients with CCA occlusion.

No MeSH data available.


Related in: MedlinePlus

Ultrasound findings of left ophthalmic artery before (a) and after (b) superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. Note the decrease in systolic velocity of retrograde blood flow in the ophthalmic artery (arrows)
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Figure 3: Ultrasound findings of left ophthalmic artery before (a) and after (b) superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. Note the decrease in systolic velocity of retrograde blood flow in the ophthalmic artery (arrows)

Mentions: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery (ICA) stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the operated CCA was completely occluded. Additional surgery was not performed. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Neurological examination on admission revealed anisocoria. The size of pupils was 3.5 mm and 5.5 mm in the right and left side, respectively. Light reflex was absent in the left side. Left visual disturbance was severe (20/400 vision). Intraocular pressure was elevated up to 38 mmHg in the left side. No parenchymal lesion was observed on brain magnetic resonance (MR) imaging. However, MR angiography demonstrated that the left CCA and left vertebral artery were completely occluded. 123I-IMP single photon emission computed tomography (SPECT) showed an impaired reactivity to acetazolamide in the territory of the left ICA [Figure 1]. On cerebral angiography, the left CCA was occluded at the origin. Left anterior cerebral artery and MCA were opacified via the anterior communicating artery on right carotid angiogram. Left subclavian angiogram showed the development of collateral circulation to the left ICA through the left ECA. Thus, the deep cervical artery extensively supplied collateral blood flow to the distal part of the left occipital artery. The blood flowed to the proximal part of the left ECA with a retrograde fashion, and then to the left ICA via the left ophthalmic artery [Figure 2]. At the same time, the left STA was opacified without a significant delay [Figure 2]. Ultrasound examination also revealed the reversed blood flow in the left ophthalmic artery. The peak systolic flow velocity was −40 cm/s, suggesting that ocular ischemia was closely related to severe neovascular glaucoma in this case [Figure 3].[7]


Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion.

Yamamoto S, Kashiwazaki D, Akioka N, Kuwayama N, Kuroda S - Surg Neurol Int (2015)

Ultrasound findings of left ophthalmic artery before (a) and after (b) superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. Note the decrease in systolic velocity of retrograde blood flow in the ophthalmic artery (arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496833&req=5

Figure 3: Ultrasound findings of left ophthalmic artery before (a) and after (b) superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. Note the decrease in systolic velocity of retrograde blood flow in the ophthalmic artery (arrows)
Mentions: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery (ICA) stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the operated CCA was completely occluded. Additional surgery was not performed. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Neurological examination on admission revealed anisocoria. The size of pupils was 3.5 mm and 5.5 mm in the right and left side, respectively. Light reflex was absent in the left side. Left visual disturbance was severe (20/400 vision). Intraocular pressure was elevated up to 38 mmHg in the left side. No parenchymal lesion was observed on brain magnetic resonance (MR) imaging. However, MR angiography demonstrated that the left CCA and left vertebral artery were completely occluded. 123I-IMP single photon emission computed tomography (SPECT) showed an impaired reactivity to acetazolamide in the territory of the left ICA [Figure 1]. On cerebral angiography, the left CCA was occluded at the origin. Left anterior cerebral artery and MCA were opacified via the anterior communicating artery on right carotid angiogram. Left subclavian angiogram showed the development of collateral circulation to the left ICA through the left ECA. Thus, the deep cervical artery extensively supplied collateral blood flow to the distal part of the left occipital artery. The blood flowed to the proximal part of the left ECA with a retrograde fashion, and then to the left ICA via the left ophthalmic artery [Figure 2]. At the same time, the left STA was opacified without a significant delay [Figure 2]. Ultrasound examination also revealed the reversed blood flow in the left ophthalmic artery. The peak systolic flow velocity was −40 cm/s, suggesting that ocular ischemia was closely related to severe neovascular glaucoma in this case [Figure 3].[7]

Bottom Line: His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma.Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery.His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.

ABSTRACT

Background: Common carotid artery (CCA) occlusion sometimes requires surgical revascularization to resolve persistent cerebral/ocular ischemia. High-flow bypass is often indicated in these cases, using the interposed graft such as saphenous vein and radial artery. However, high-flow bypass surgery is invasive and may provide excessive blood flow to ischemic brain. In this report, we present a case that developed neovascular glaucoma due to CCA occlusion and was successfully treated with superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis.

Case description: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the CCA was occluded. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Blood flow measurement showed an impaired reactivity to acetazolamide in the left cerebral hemisphere. Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery. Therefore, he successfully underwent left STA-MCA double anastomosis. His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

Conclusions: Precise radiological examination may enable standard STA-MCA anastomosis even in patients with CCA occlusion.

No MeSH data available.


Related in: MedlinePlus