Abstract
Direct revascularization surgery, such as superficial temporal artery (STA)-middle
cerebral artery (MCA) bypass, is effective in preventing ischemia and hemorrhage for
moyamoya disease. On the other hand, when ischemia of the anterior cerebral artery
(ACA) region progresses after ipsilateral STA-MCA bypass, it is difficult to perform
revascularization from the viewpoint of the donor artery. A 55-year-old woman with
right hemiparesis was diagnosed with cerebral infarction due to moyamoya disease.
Left STA-MCA bypass was performed with no postoperative complications, but memory
impairment and decreased motivation were observed 2 months after the operation. Magnetic
resonance imaging and angiography revealed new infarction in the bilateral ACA area
and deterioration in the signal intensity of bilateral ACAs. Revascularization of
the bilateral ACA regions was considered necessary, but the left STA was already used
in the previous surgery. Therefore, STA-radial artery (RA)-A3 bypass using RA graft
combined with right STA-MCA bypass was performed. STA-A3 bypass using an RA graft
may be the optimal treatment for ischemia of the ACA region that progresses after
STA-MCA bypass.
Keywords
moyamoya disease - anterior cerebral artery - bypass surgery - radial artery
