Abstract
IntroductionWhile catheter angiography has traditionally been used to assess the caliber and course of the superficial temporal artery prior to its use as a conduit for external carotid artery to internal carotid artery (EC-IC) bypass, computed tomographic angiography (CTA) has become increasingly used in the diagnostic assessment of cerebral vasculature. We demonstrate the application of CTA for evaluation of the superficial temporal artery as a vascular conduit for EC-IC bypass.Case presentationA female in the fourth decade of life presented with the chief complaint of headache. CTA of the Circle of Willis revealed an unruptured fusiform aneurysm of the M1 segment of the right middle cerebral artery (MCA). We performed CTA for the preoperative assessment of the STA for a putative EC-IC bypass procedure, and correlated this to conventional external carotid angiography. Reformatted CTA provided excellent surface visualization of the STA and its course in relationship to the cranial and zygomatic surfaces, and correlated well with findings on the conventional angiogram.ConclusionCTA may eventually prove sufficient for use in assessing the STA in preparation for EC-IC bypass.
Highlights
While catheter angiography has traditionally been used to assess the caliber and course of the superficial temporal artery prior to its use as a conduit for external carotid artery to internal carotid artery (EC-IC) bypass, computed tomographic angiography (CTA) has become increasingly used in the diagnostic assessment of cerebral vasculature
CTA may eventually prove sufficient for use in assessing the superficial temporal artery (STA) in preparation for EC-IC bypass
Selective external carotid artery digital subtraction angiography was performed in a biplane angiography suite according to standard protocol
Summary
External carotid artery to internal carotid artery (EC-IC) bypass using the superficial temporal artery (STA) for cerebral revascularization is an important technique for a variety of complex cerebrovascular lesions. Invasive catheter angiography has traditionally been used to assess the caliber and course of the STA prior to its use as a conduit for EC-IC bypass. Computed tomographic angiography (CTA) has become increasingly used in the diagnostic assessment of cerebrovascular disease [1,2]. Conventional catheter angiography may be necessary in the evaluation of chronic ischemic disease to assess the distal cerebral vasculature and identify potential recipient vessels for bypass. Catheter angiography could potentially be avoided when bypass for intracranial aneurysm is planned. In this case illustration, we demonstrate application of CTA for evaluation of the superficial temporal artery as a vascular conduit for EC-IC bypass
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