Intraoperative Neuroendovascular Rescue Therapy for Severe Donor Artery Vasospasm In Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery: A Case Report

Abstract

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is a useful cerebral revascularization procedure adopted for the treatment of various cerebrovascular diseases. However, STA, as the donor artery, may become narrowed intraoperatively, and this phenomenon, if left un-noticed, could lead to graft failure or cerebral ischemia despite of a successful anastomosis procedure. Therefore, early detection and treatment of the STA problems will be mandatory. We described a case of 51-yearold male with medically refractory right MCA stenosis who had undergone STA-MCA bypass. After a successful anastomosis, however, a hemodynamically relevant vasospasm of the STA was confirmed immediately by the intraoperative angiography. To treat the vasospasm, the STA pedicle was catheterized with a microcatheter, and 3 mg of nimodipine was infused within the STA with good angiographic responses. This salvage procedure rescued the bypass graft successfully without complications. In this case, we demonstrated that vasospasm of the donor artery could be detected and salvaged early by intra operative neuro-endovascular procedures. This hybrid approach, which utilized advantages of both neurosurgical and neuroendovascular procedures as mutual back-ups, would become the mainstay of treatment strategies for cerebrovascular diseases in the modern era.