Simultaneous Left Superficial Temporal Artery-Middle Cerebral Artery Bypass and Encephalodurovenosynangiosis for Progressive Atherosclerosis of the Left Internal Carotid Artery Communicating Segment.

Abstract

Combined direct and indirect bypass have been described in the literature as a complementary technique.¹ Direct superficial temporal artery-to-middle cerebral artery bypass is a cornerstone for adult moyamoya disease and syndrome as it provides immediate vascular supply.² However, the donor vessel caliber and thus blood flow are subject to decrease over time, mainly due to new collateral formation.³ Encephaloduroarteriosynangiosis provides long-term blood supply and new collateral formation. We describe a case of progressive left internal carotid artery communicating segment atherosclerosis in a 34-year-old woman. An indirect bypass using the superficial temporal vein was chosen on the basis of absence of the left parietal branch of the superficial temporal artery.