Diagnostic impact of superficial temporal artery duplex ultrasonography for evaluating cerebral hemodynamics before and after extracranial–intracranial bypass surgery in the setting of common carotid artery occlusion and spontaneous bonnet bypass: a case report

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  • KANAZAWA Makoto
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
  • FUJIMOTO Shigeru
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital Stroke Center, Jichi Medical University
  • NAKAMIZO Akira
    Department of Neurosurgery, Stroke Center, Steel Memorial Yawata Hospital
  • OSAKI Masato
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
  • KUMAMOTO Masaya
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
  • TAGAWA Naoki
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
  • OHYA Yuichiro
    Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital
  • YAMAGUCHI Shinnya
    Department of Neurosurgery, Stroke Center, Steel Memorial Yawata Hospital
  • TUCHIMOCHI Ryosuke
    Department of Neurosurgery, Stroke Center, Steel Memorial Yawata Hospital
  • KOYANAGI Yuya
    Department of Neurosurgery, Stroke Center, Steel Memorial Yawata Hospital
  • KITAZONO Takanari
    Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 対側浅側頭動脈からの側副血行を有する総頸動脈閉塞に対するバイパス術前後の血行動態の評価に浅側頭動脈超音波検査が有用であった一例

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A 77-year-old man with a history of radiation therapy for pharyngeal cancer and consequent asymptomatic left common carotid artery (CCA) occlusion showed asymptomatic ischemic stroke and left transient monocular blindness, and he was admitted to our hospital. He was found to have an indication for bypass surgery because of a remarkable reduction in cerebral blood flow in the ipsilateral middle cerebral artery (MCA) territory. Carotid ultrasonography revealed retrograde blood flow of the ipsilateral external carotid artery (ECA) and a U-turn phenomenon to the internal carotid artery (ICA). Cerebral angiography demonstrated spontaneous bonnet bypass flow from the right superficial temporal artery (STA) to the left STA, but the blood flow via the bypass was not enough to supply the left MCA. Bypass surgery to anastomose the bonnet bypass to the left MCA was performed, and postsurgical cerebral blood flow to the ipsilateral MCA territory improved. On STA duplex ultrasonography (STDU), the pulsatility index value of the contralateral STA changed from an ECA pattern before surgery to an ICA pattern after. Moreover, postsurgical mean flow velocity of the bonnet bypass to the left MCA was relatively higher than the presurgical retrograde mean flow velocity of the left STA. These ultrasonographic findings correlated with those on single photon emission computed tomography (SPECT) and cerebral angiography. As demonstrated in the present case, ultrasonography including STDU is useful in the evaluation of cerebral hemodynamics before and after cerebral artery bypass surgery and in the usual STA-MCA anastomosis.

Journal

  • Neurosonology

    Neurosonology 29 (1), 47-52, 2016

    The Japan Academy of Neurosonology and Embolus

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