Revascularization for Aplastic or Twiglike Middle Cerebral Artery: A Case Report.

An aplastic or twiglike middle cerebral artery (Ap/T-MCA) is a congenital anomaly related to interference of normal embryonic development of the middle cerebral artery (MCA). This condition may cause ischemic and hemorrhagic strokes as a result of hypoperfusion, vulnerable collateral circulation, and associated aneurysms. We reported a case of Ap/T-MCA with transient ischemic attack, which was successfully treated with revascularization. A 19-year-old woman with a history of transient left upper limb hemiparesis, dysesthesia, and headache visited our hospital. Digital subtraction angiography showed an occlusion in the M1 segment of the MCA and abnormal vascular networks distal to the occlusion site. The patient underwent direct and indirect revascularizations, including superficial temporal artery-to-MCA bypass and encephalomyosynangiosis. She was discharged home without any neurological deficit. Magnetic resonance angiography at 12 months after revascularization showed regression of blood flow signals at the twigs network. In spite of congenital anomaly, revascularization for an Ap/T-MCA may be useful to reduce collateral stress in microvascular networks and to prevent future stroke in selected patients.