Rescue Extracranial–Intracranial Bypass for Ischemic Stroke Secondary to Progressive Human Immunodeficiency Virus–Associated Vasculopathy

Abstract

Background Human immunodeficiency virus (HIV) associated vasculopathy can cause ischemic cerebral stroke; however, there is limited evidence on optimal management. Herein, we report a case of acute ischemic stroke due to progressive internal carotid artery (ICA) stenosis in an HIV-positive patient. Superficial temporal artery to middle cerebral artery (STA-MCA) bypass, in addition to the best medical treatments, prevented stroke progression.

Clinical Description A 39-year-old man with HIV infection presented with a sudden onset of aphasia and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left basal ganglia and concentric thickening of the vessel wall in the terminal portion of the bilateral ICAs. Despite maximal medical treatments for HIV-associated vasculopathy and possible opportunistic infections, bilateral ICA stenoses progressed, leading to a second hemodynamic stroke event. Because tissue plasminogen activator treatment failed, we performed STA-MCA bypass. A significant improvement in neurologic symptoms and cerebral blood flow was observed after surgery. No further stroke events occurred during the continuation of medical treatments.

Conclusion This is the first case of STA-MCA bypass performed in a patient with recurrent ischemic stroke caused by HIV-associated vasculopathy. Although further evidence is needed, such treatment options can shed new light on the management of progressive HIV-associated vasculopathy, which is refractory to maximal medical treatment.

Keywords

acquired immunodeficiency syndrome - EC-IC bypass - STA-MCA bypass - vessel wall magnetic resonance imaging

Informed Consent

Informed consent was obtained from the patient included in the study.

Publication History

Received: 06 January 2022

Accepted: 21 February 2022

Accepted Manuscript online:
22 February 2022

Article published online:
12 July 2022

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