Hemodynamic ischemia of the anterior choroidal artery and reversal by carotid artery stenting 10 years after ipsilateral superficial temporal artery-middle cerebral artery bypass for symptomatic left middle cerebral artery stenosis.

Hayato Suzuki,Hiroaki Shimizu,Katsuhiro Nishino,Suguru Yamaguchi,Taizen Nakase

doi:10.4081/ni.2018.7867

Hayato Suzuki, Hiroaki Shimizu + Show 3 more

Open Access

https://doi.org/10.4081/ni.2018.7867

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Journal: Neurology international	Publication Date: Dec 5, 2018
License type: CC BY-NC 4.0

Affiliation: Akita University

Abstract

The pathogenesis of anterior choroidal artery (AChA) territory infarction includes various mechanisms, but hemodynamic causes are rare and difficult to diagnose. 77- year-old man, who had moderate left ICA stenosis and he had treated with STA-MCA bypass surgery for severe symptomatic left MCA stenosis 10 years earlier, was admitted with right hemiparesis and confused state. On admission, magnetic resonance imaging and angiography demonstrated patent bypass, but severe stenosis of left ICA with no opacification of the left AChA and A1 portion of the left ACA. Diffusionweighted imaging demonstrated ischemic lesion in the left corona radiata. Together with clinical findings, hemodynamic ischemia of the AChA region was suspected and left carotid artery stenting resulted in prompt improvement of symptoms. Hemodynamic ischemia of the AChA territory is rare, however, should be considered as a potential target of treatment when the ipsilateral ICA, A1 and M1 show stenoocclusive lesions.

Highlights

We treated a patient of hemodynamic ischemia in the anterior choroidal artery (AchA) territory due to acute ICA occlusion 10 years after the ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, with carotid artery stenting
Japan nly Abstract o The pathogenesis of anterior choroidal e artery (AChA) territory infarction includes various mechanisms, but hemodynamic s causes are rare and difficult to diagnose. 77u year-old man, who had moderate left ICA l stenosis and he had treated with STA-MCA ia bypass surgery for severe symptomatic left
Conventional angiography revealed near-occlusion (99% stenosis from NASCET criteria) of the left cervical internal carotid artery (Figure 1C), a patent STA-MCA bypass with occlusion of the left M1 (Figure 1D) and severe stenosis of left A1 was visualized via the anterior communicating artery (ACoA) (Figure 1E)

Summary

Introduction

We treated a patient of hemodynamic ischemia in the anterior choroidal artery (AchA) territory due to acute ICA occlusion 10 years after the ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, with carotid artery stenting. Together -c with clinical findings, hemodynamic ischemia of the AChA region was suspected n and left carotid artery stenting resulted in o prompt improvement of symptoms. At the time of his admission, his neurological findings were confused state (Glasgow Coma Scale; E1V1M4), dysarthria, and right hemiparesis (manual muscle testing: upper limbs 4/5 lower limbs 3/5).

Results

Conclusion