Aplastic or twig-like middle cerebral artery with short-term ischemia and bleeding

Abstract

A68・year-oldman presented with acute cerebral infarction. At the time of admission， computed tomography an- giography showed occlusion and anomalous reticular collateral artery only in the right M 1 part of the middle cerebral 紅白ry(MCA) and there was no stenosis or occlusion in the terminus of the internal carotid artery. The patient was diagnosed with an aplastic or twig-like MCA. We planned superficial temporal artery-MCA anastomosis with low cerebrovascular reservation in the right MCA area. However， the patient developed right thalamic hemorrhage while waiting for the operation. A small aneurysm was present in collateral circulation. The rupture of this aneurysm or col- lateral vessels was suspected as a source of bleeding and antiplatelet agents introduced after cerebral infarction was also thought to be an inftuence. In this case， bypass surgery was performed， considering that improvement of hemody- namic cerebral ischemia is e百ectivein preventing rebleeding. In the postoperative follow up， the aneurysm and collat- eral arteries disappeared and no cerebrovascular event occurred in 26 months.