You-Sub Kim1, Myeong-Hun Ha1, Sung-Pil Joo1, Tae-Sun Kim2. 1. Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea. 2. Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea. Electronic address: taesun1963@yahoo.co.kr.
Abstract
BACKGROUND: Thrombosed intracranial aneurysms are complex and unstable lesions that are especially associated with ischemic stroke. Although acute parent artery occlusion manifesting with ischemic stroke is very rare, it can lead to catastrophic consequences. CASE DESCRIPTION: This study presents 2 cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery bifurcation aneurysms manifesting with ischemic stroke. Both patients were successfully treated with emergent double-barrel superficial temporal artery-to-middle cerebral artery bypass followed by aneurysm trapping. CONCLUSIONS: Emergent superficial temporal artery-to-middle cerebral artery bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion- and perfusion-weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides diffusion- and perfusion-weighted imaging, preoperative assessment of the collaterals will help in predicting postoperative prognosis.
BACKGROUND:Thrombosed intracranial aneurysms are complex and unstable lesions that are especially associated with ischemic stroke. Although acute parent artery occlusion manifesting with ischemic stroke is very rare, it can lead to catastrophic consequences. CASE DESCRIPTION: This study presents 2 cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery bifurcation aneurysms manifesting with ischemic stroke. Both patients were successfully treated with emergent double-barrel superficial temporal artery-to-middle cerebral artery bypass followed by aneurysm trapping. CONCLUSIONS: Emergent superficial temporal artery-to-middle cerebral artery bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion- and perfusion-weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides diffusion- and perfusion-weighted imaging, preoperative assessment of the collaterals will help in predicting postoperative prognosis.