One way to restore blood flow to the brain is to use an artery that normally goes to the scalp (either the superficial temporal artery (STA) or occipital artery) and connect it to a brain blood vessel after performing a craniotomy. This procedure is called a “direct bypass”. This procedure does require both the donor scalp blood vessel and recipient brain blood vessel to be of sufficient size. The most common donor is the superficial temporal artery (STA) and the most common recipient is the middle cerebral artery (MCA) of the brain, this form of direct bypass is called an “STA-MCA bypass”. STA-MCA bypass is the preferred treatment for patients with MMS and MMD (where there is no known medical or endovascular treatment option shown to help patients). Very rarely, we use an artery in the arm (radial artery) or leg (tibial artery) to connect the carotid artery in the neck to the blood vessels of the brain to supply more blood flow. We are one of the only centers in the state and region to offer direct bypasses to patients. Patients with this surgery take a full dose of aspirin for approximately 1 year and then decrease to baby aspirin thereafter.
If the recipient or donor blood vessels are not viable or large enough to perform a direct bypass, we can perform an indirect revascularization procedure where a piece of scalp tissue (muscle, the STA, etc.) or meninges is laid on top of the brain after performing craniotomy for blood vessels to grow over time and help flow to the brain. This procedure also has excellent results in preventing strokes and TIAs in patients with MMS and MMD.
For carotid stenosis in the neck, oftentimes we can offer surgery to open the carotid artery in the neck and remove the plaque to reduce the risk of having a stroke or TIA. For patients with carotid stenosis, each case is different, and we will discuss the benefits and risks of both using a stent and surgical removal of the plaque.