Internal maxillary artery (IMax) – middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report
10.7461/jcen.2023.E2022.11.003
- Author:
Javier DEGOLLADO-GARCÍA
1
;
Martin R. CASAS-MARTÍNEZ
;
Bill Roy Ferrufino MEJIA
;
Juan C. BALCÁZAR-PADRÓN
;
Héctor A. RODRÍGUEZ-RUBIO
;
Edgar NATHAL
Author Information
1. Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
- Publication Type:Case Report
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2024;26(1):51-57
- CountryRepublic of Korea
- Language:English
-
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.
