De Novo Aneurysm Formation at the Anastomosis Site Incidentally Detected 2 Years after Single-Barrel STA-MCA Bypass Surgery: Case Report and Review of the Literature

Abstract

This case report describes the de novo aneurysm formation at the anastomosis site 2 years after single-barrel superficial temporal artery to middle cerebral artery bypass surgery. Correct bypass patency and morphology of the anastomosis site was documented intraoperatively and immediately postoperatively by indocyanine green videoangiography and digital subtraction angiography (DSA). Aneurysmatic dilatation at the anastomosis site was observed 2 years postoperatively upon computed tomography angiographic follow-up examination. After repeat DSA, the patient underwent microsurgical reexploration and clip ligation of the aneurysmatic portion of the donor artery. The possible underlying mechanisms are discussed and the current literature is reviewed.

Superficial Temporal Artery to the Middle Cerebral Artery Anastomotic Aneurysm Treated With an Endovascular Approach: A Case Report

“…[8][9][10][11] According to our knowledge, this is the first case of STA-MCA bypass aneurysm that was successfully treated through an endovascular approach. 6,[8][9][10][11][12][13][14][15][16][17][18][19] Endovascular treatment has been widely used in the setting of graft stenosis and thrombosis to reestablish flow and sustain adequate cerebral perfusion. In long-term follow-up, bypass patency is maintained in approximately 90% of cases 20 with endovascular rescue approaches in the remaining 10% in an attempt to regain adequate cerebral perfusion.…”

Superficial temporal artery: Middle cerebral artery bypass, our series of 20 cases, surgical technique and indications with illustrative cases

“…The most common complications of end-to-side STA-MCA bypass are perioperative stroke and graft occlusion. Millesi et al [19] reported a case report of de novo aneurysm formation at the anastomosis side with a review of 17 cases published in the literature. Horiuchi et al [20] proposed a revision of the anastomosis in case of intraoperative occlusion.…”

Rozwój i nowe perspektywy leczenia choroby moyamoya

“…Ponowne otwarcie wytworzonego zespolenia w celu do-kładnego zbadania i skontrolowania drożności naczyń, jak również zabieg ponownego zespolenia mogą się jednak wiązać z następstwami pod postacią niedrożności obu zespalanych naczyń [24,30]. Warto też wspomnieć, że jednym z pooperacyjnych powikłań STA-MCA może być także wytworzenie de novo tętniaka [31]. Ważne jest, aby u chorych poddawanych tego rodzaju rekonstrukcji stosować w okresie okołooperacyjnym leki przeciwpłytkowe oraz utrzymywać prawidłowe ciśnienie tętnicze w trakcie wykonywanego zabiegu, co zmniejsza ryzyko powikłań, a także zapewnia odpowiednią drożność wytworzonego zespolenia [32].…”