FREQUENT TIA IN THE TERRITORY FED BY THE ANASTOMOSED STA AFTER COMBINED THERAPEUTIC ICA OCCLUSION AND EXTRACRANIAL-INTRACRANIAL BYPASS - CASE-REPORT

Frequent transient ischaemic attacks (TIAs) in the territory fed by th e anastomosed superficial temporal artery (STA) after combined therape utic internal carotid artery (ICA) occlusion and extracranial-intracra nial bypass is described in a 52-year-old woman with a giant aneurysm in the supraclinoid portion of the left ICA showing impairment of visu al acuity in the left eye and right upper quadrantanopia. After the ba lloon test occlusion of the left ICA which was tolerated, the left STA -middle cerebral artery anastomosis was performed and occlusion of the left ICA using detachable balloons was carried out a day later. TIAs corresponding to the territory fed by the anastomosed STA occurred nin e times two to four days and five times eight to nine days after the I CA occlusion without new infarction on computed tomography (CT) scan. Single-photon emission computed tomography showed no hypoperfusion imm ediately after the initial TIA. CT scan revealed thrombosis of half of the aneurysm a day after the ICA occlusion. The patient developed the same TIA as previously by compression of the left anastomosed STA at the time of follow-up angiography which was carried out eight days aft er the occlusion. Although heparin was continuously administered after the ICA occlusion for two days, the initial TIA occurred during hepar inization. Anticoagulation seemed to be inadequate judging from activa ted coagulation time and incomplete thrombosis of the aneurysm occurre d during heparinization. It is likely that the TIAs are caused by embo lism via the STA, which is a rare ischaemic complication.