Staged Common and External Carotid Artery Stenting Followed by Superficial Temporal Artery to Middle Cerebral Artery Bypass

• Published in: Journal of neurological surgery. Part A, Central European neurosurgery Vol. 85; no. 4; p. 412
• Main Authors: Mulcahy, Michael, Presti, Anna Lo, Veken, Jorn Paul Van Der, Steinfort, Brendan, Assaad, Nazih
• Format: Journal Article
• Language: English
• Published: Germany 01-07-2024
• Subjects: Aged; Carotid Artery, Common - surgery; Carotid Artery, External - diagnostic imaging; Carotid Artery, External - surgery; Carotid Artery, Internal - surgery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Cerebral Revascularization - methods; Female; Humans; Male; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Stents; Temporal Arteries - surgery; Treatment Outcome
• ISSN: 2193-6323
• DOI: 10.1055/a-1832-3158

Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery for internal carotid artery (ICA) occlusive disease necessarily requires sufficient external carotid artery (ECA) blood flow. Surgical bypass is therefore precluded if there is common carotid artery (CCA) occlusion. Here we present two such cases: one patient had a CCA occlusion and the other had an ICA occlusion and ECA stenosis. Both had failed medical management, and were therefore treated with angioplasty and stenting of the ECA, followed by STA-MCA bypass. We describe the clinical and radiologic outcomes of these cases, and remark on the potential pitfalls associated with this novel approach.