Extracranial–intracranial bypass for Takayasu’s arteritis: A case report

Objective: Takayasu’s arteritis is a rare disease that often affects the great vessels at the origin as they branch from the aortic arch. There are numerous case series and case reports in the cardiothoracic literature describing carotid bypass to reestablish blood flow past the areas of stenosis. We present a rare case of thrombus forming in the distal ICA and occluding intracranial vessels, thus necessitating neurosurgical evaluation and intervention. Methods: This is a case report of a 21-year-old right-handed female who presented with right-sided hemiplegia, facial weakness, and language impairment. Radiological imaging showed occlusion of the left middle cerebral artery (MCA) and bilateral distal carotids. MR angiogram of the head and neck confirmed the above findings and also showed high-grade stenosis of the right vertebral artery at its origin. An EC–IC bypass was necessary to maintain perfusion to the left side of her cortex and to prevent further neurological deficits. Results: At the 9 month follow-up, her overall neurological exam has improved from complete paralysis on the right side to more than antigravity in her motor strength assessment. The follow-up imaging showed that the bypass remained patent while the ICA remained occluded. Conclusion: STA–MCA bypass to enhance cerebral blood flow in the setting of stroke symptoms due to Takayasu’s arteritis can serve as a bridge before definitive cardiothoracic treatment of the great vessels