A case of a brain stem infarction caused by basilar artery occlusion treated with superficial temporal Artery-Superior cerebellar artery bypass surgery

Abstract

Background and importance: The ideal treatment for progressive stroke based on basilar artery occlusion (BAO) has yet to be established. Catheter revascularization is a method primarily used to treat acute cases, but its efficacy remains unclear for nonacute cases.Even today, in some cases, a deep-site bypass for an ischemic stroke should be effective, if chosen carefully. We discuss the treatment strategy by presenting a case treated with a superficial temporal artery-superior cerebellar artery (STA-SCA) bypass. Clinical presentation: We present the case of a 45-year-old male with chronic kidney disease (CKD) who presented to our hospital with mild tetraplegia and consciousness disturbance. Magnetic resonance imaging (MRI) confirmed an infarction of the bilateral ventral pons. Digital subtraction angiography (DSA) showed that the basilar artery (BA) was completely obstructed on the distal side, including the bilateral superior cerebellar arteries (SCAs).Even after medical treatment, the hemodynamics in the posterior circulation worsened, and the infarction spread to the bilateral cerebral peduncles. Therefore, we performed an STA-SCA bypass to provide supplemental blood flow to the distal area of the occlusion site. The operation was successful, and there was no stroke recurrence, even after tapering the antiplatelet therapy dosage. Conclusion: We report a case in which an STA-SCA bypass was effective for treating hemodynamic insufficiency caused by chronic BAO. In some cases, compared to catheter recanalization, this procedure has some advantages. Therefore, we need to reacknowledge the efficacy of surgical intervention in the treatment of nonacute basilar steno-occlusive disease.

Keywords

• Basilar artery occlusion
• Progressive stroke
• STA-SCA bypass