Endovascular stenting for rescue of a failed donor graft during superficial temporal artery to middle cerebral artery bypass surgery: case report

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Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.

The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.

This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.

ABBREVIATIONS ACA = anterior cerebral artery; EC-IC = extracranial-intracranial; ICA = internal carotid artery; ICG = indocyanine green; MCA = middle cerebral artery; STA = superficial temporal artery; tPA = tissue plasminogen activator.
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Contributor Notes

Correspondence Sandi K. Lam: Texas Children’s Hospital, Baylor College of Medicine, Houston, TX. sklam@texaschildrens.org; sandi.lam@bcm.edu.INCLUDE WHEN CITING Published online August 9, 2019; DOI: 10.3171/2019.5.PEDS1977.Disclosures Dr. Kan reports being a consultant for Stryker Neurovascular and Cerenovus and being an owner of InNeuroCo and Vena Medical.
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