STA-MCASuperficial Temporal Artery to Middle Cerebral Artery
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STA-MCA anastomosis, which can be indicated for atherosclerotic diseases as well as moyamoya disease [1,11], is another surgical procedure in which CHPS can occur [2, 3].
In the present case, the initial presentation of CHPS appears typical in terms of the symptoms as well as the pattern of hyperperfusion on SPECT, because the area of hyperperfusion is frequently in localized brain cortex after STA-MCA anastomosis [6-8], and the focal neurologic signs in accordance with the anatomical location of the site of anastomosis are the most frequent symptoms in STA-MCA bypass surgery [6].
There are two cases showing long duration of CHPS after STA-MCA bypass reported in the literature, both of which were the patients with moyamoya disease [6,14].
In our case, the cerebral vessels had presumably been exposed to D2 antagonist for a long time; thus, they might have sustained the impairment of vasoconstriction or BBB, leading to prolonged dilatation of the vessels or impaired oxygen metabolism following the increase of CBF after STA-MCA bypass surgery.
STA-MCA surgical anastomosis was developed in 1967 and routinely performed on patients with carotid occlusion throughout the 1970s and mid-1980s.
The accepted first choice of treatment is the direct method which includes superficial temporal artery and middle cerebral artery (STA-MCA) anastomosis combined with indirect revascularization [11].