A Case of Progressing Stroke treated with a "Hemi-bonnet Bypass" A3-RA Graft-STA Anastomosis

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  • 橈骨動脈を用いた健側浅側頭動脈本幹から患側前大脳動脈への"hemi-bonnet bypass"にて急性期血行再建を行った進行性脳梗塞の1例

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We herein report a case of progressing stroke treated with a "hemi-bonnet bypass" A3-RA graft-STA anastomosis. An 86-year-old female suffered sudden onset right hemiparesis, and was diagnosed with a cerebral infarction. CT angiography at 24 hours after symptom onset revealed a left common carotid artery obstruction. A CT perfusion study revealed reduction of the cerebral blood flow in the territory of the bilateral anterior cerebral arteries and left middle cerebral artery. At 48 hours after symptom onset, her neurological status deteriorated to NIHSS 19 with akinetic mutism from 2. A diffusion MRI study revealed no marked changes in the spotty infarctions in the watershed region of the left anterior and middle cerebral arteries. We therefore performed a "hemi-bonnet bypass", left A3-right radial artery graft-right superficial temporal artery anastomosis. Her neurological status improved to NIHSS 5 on post-operative day 1. She underwent rehabilitation, and was discharged with NIHSS 2 and mRS 2. The "hemi-bonnet bypass" requires a short distance of graft vessel (allowing for the possible use of the radial artery), and does not need a position change during the operation. However, the cerebral blood flow from the ACA-A3 to MCA and contralateral A2 depend on the development of ipsilateral ACA-A1 and an anterior communicating artery. Therefore, if the ACA-A3 is selected as the recipient vessel, careful observation of the circle of Willis is essential.

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