Superficial temporal artery to middle cerebral artery bypass and external carotid reconstruction for carotid restenosis after angioplasty and stent placement

The recent proliferation of endovascular treatment of carotid atherosclerot ic disease will increase the number of patients who require treatment for r ecurrent carotid stenosis after angioplasty and stent placement, The optima l management of these patients has not yet been defined. We describe a 66-y ear-old woman who required 2 surgical procedures for recurrent in-stent car otid stenosis, She experienced numerous transient ischemic attacks 5 months after left extracranial internal carotid artery angioplasty and stenting f or asymptomatic stenosis, Angiography showed high-grade in-stent restenosis , left intracranial carotid artery stenosis, and poor collateral flow to th e left middle cerebral artery circulation, The patient underwent a Superfic ial temporal artery to middle cerebral artery bypass, and the transient isc hemic attacks resolved, Five months later, angiography showed progressive s tenosis of the external carotid artery at the site of the stent, The patien t underwent successful external carotid reconstruction with an on lay patch , Extracranial-intracranial bypass grafting maybe used successfully in the treatment of recurrent extracranial carotid artery stenosis after angioplas ty and stent placement, Also, external carotid artery reconstruction at the site of an internal carotid artery stent can be performed safely.