title: Risky Cerebrovascular Anatomic Orientation: Implications for Brain Revascularization.
abstract: This study documents a risky vascular anatomic orientation that might play an important role in the postoperative hemodynamics following anterior cerebral artery (ACA) revascularization. A 71-year-old woman presented with uncontrollable frequent right lower limb transient ischemic attacks (TIAs) attributed to a left cerebral ischemic lesion due to severe left ACA stenosis. She underwent successful left-sided superficial temporal artery-ACA bypass using interposed vascular graft. The patient awoke satisfactory from anesthesia; however, on postoperative day 1, she developed right-sided hemiparesis. Extensive postoperative investigations disclosed that watershed shift infarction was considered the etiology for this neurologic deterioration.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr City, Cairo, Egypt. Electronic address: nagm@shinshu-u.ac.jp.
authors.forename: Alhusain
authors.initials: A
authors.lastname: Nagm
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Yanagawa
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
mesh_terms: D000368:Aged; D020771:Anterior Cerebral Artery / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology*; D002548:Cerebral Revascularization / Q000379:methods*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D012307:Risk Factors; D013699:Temporal Arteries / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
keywords: Anterior cerebral artery; Cerebral ischemia; Cerebral watershed infarction; Extracranial (EC)-Intracranial (IC) bypass; Revascularization; STA-ACA bypass graft