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Aplastic or twiglike middle cerebral artery with contralateral middle cerebral artery stenosis showing transient

Hayato Takeda1, Kiyoyuki Yanaka1, Kuniyuki Onuma1

  • 1Department of Neurosurgery, Tsukuba Memorial Hospital, Ibaraki, Japan; and.

Journal of Neurosurgery. Case Lessons
|June 23, 2022
PubMed
Abstract

Insights

Aplastic or twiglike middle cerebral artery (Ap/T-MCA) is a rare condition causing strokes. Bypass surgery effectively treated a patient with Ap/T-MCA and transient ischemic attacks, suggesting its promise for ischemic conditions.

Area of Science:

  • Neuroscience
  • Vascular Neurology
  • Cerebrovascular Diseases

Background:

  • A rare unilateral middle cerebral artery (MCA) occlusion with plexiform vessels, termed aplastic or twiglike MCA (Ap/T-MCA), can lead to hemorrhagic and ischemic strokes.
  • The underlying mechanisms of ischemic events in Ap/T-MCA are poorly understood, making treatment strategies controversial.

Observation:

  • A 62-year-old male presented with recurrent transient ischemic attacks.
  • Imaging revealed right MCA occlusion and left MCA stenosis, consistent with Ap/T-MCA.
  • Superficial temporal artery-MCA bypass surgery was performed after antiplatelet therapy proved insufficient.

Findings:

  • Atherosclerosis significantly contributes to ischemic stroke development in Ap/T-MCA patients.
  • Coexisting atherosclerotic stenotic lesions outside the Ap/T-MCA site are crucial in disease progression.

Implications:

  • Bypass surgery presents a viable and promising therapeutic option for managing ischemic Ap/T-MCA.
  • Understanding the role of atherosclerosis in Ap/T-MCA is vital for future treatment development.
Keywords:
Ap/T-MCA = aplastic or twiglike middle cerebral arteryCBF = cerebral blood flowDSA = digital subtraction angiographyEMS = encephalomyosynangiosisICA = internal carotid arteryMMD = moyamoya diseaseMRI = magnetic resonance imagingSPECT = single-photon emission computed tomographySTA = superficial temporal arteryTIA = transient ischemic attackaplastic or twiglike middle cerebral arteryatherosclerosisbypass surgeryischemia

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