Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report

  • Javier Degollado-Garcia (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery ) ;
  • Martin R. Casas-Martinez (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery ) ;
  • Bill Roy Ferrufino Mejia (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery ) ;
  • Juan C. Balcazar-Padron (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery ) ;
  • Hector A. Rodriguez-Rubio (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery ) ;
  • Edgar Nathal (Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery )
  • Received : 2022.11.03
  • Accepted : 2023.05.12
  • Published : 2024.03.31
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Abstract

Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.

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References

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