We report a case of progressive cerebral infarction due to middle cerebral artery (MCA) stenosis treated with balloon percutaneous transluminal angioplasty (PTA), followed by superficial temporal artery -to-middle cerebral artery (STA-MCA) bypass.An 82-year-old man was admitted to our hospital for sudden left hemiparesis. Magnetic resonance imaging (MRI) demonstrated severe stenosis in his right MCA and multiple cerebral infarctions in the corresponding region. In spite of our initial aggressive medical management, the patient presented with left hemispatial neglect on day five. MRI showed enlarged lesions. Accordingly, we conducted urgent balloon PTA in order to avoid aggravation. Although the MCA was dilated sufficiently, restenosis was a concern from a long-term perspective because the lesion was longer than 10 mm. Therefore, we added STA-MCA bypass subsequently on day 11. No further infarction was detected after both treatments. The patient was discharged after four months of rehabilitation. Computed tomography angiography (CTA) on day 90 showed restenosis of the MCA. These observations suggest that early STA-MCA bypass may have prevented stroke progression.

We report a case of ruptured distal posterior inferior cerebellar artery (PICA) aneurysm with large hematoma in the fourth ventricle that was treated by endovascular therapy after endoscopic evacuation of the hematoma.A 65-year-old man presented with a deep coma and was transferred to our hospital. Computed tomography (CT) scan revealed a large hematoma in the fourth ventricle. CT angiography did not demonstrate any aneurysms. Thereafter, emergent endoscopic evacuation of the hematoma was performed to relieve brain stem compression and hydrocephalus. Cerebral angiography was done immediately after the operation, and a distal PICA aneurysm was detected. The aneurysm was treated by coil embolization. The patient was able to walk with a cane and was discharged after undergoing rehabilitation for seven months.Coil embolization after endoscopic evacuation of hematoma may improve the outcome of patients with large cerebellar hemorrhage caused by ruptured aneurysm.

No abstract