• You-Sub Kim, Myeong-Hun Ha, Sung-Pil Joo, and Tae-Sun Kim.
• Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
• World Neurosurg. 2020 Apr 1; 136: 122-127.

BackgroundThrombosed intracranial aneurysms are complex and unstable lesions that are especially associated with ischemic stroke. Although acute parent artery occlusion manifesting with ischemic stroke is very rare, it can lead to catastrophic consequences.Case DescriptionThis study presents 2 cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery bifurcation aneurysms manifesting with ischemic stroke. Both patients were successfully treated with emergent double-barrel superficial temporal artery-to-middle cerebral artery bypass followed by aneurysm trapping.ConclusionsEmergent superficial temporal artery-to-middle cerebral artery bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion- and perfusion-weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides diffusion- and perfusion-weighted imaging, preoperative assessment of the collaterals will help in predicting postoperative prognosis.Copyright © 2020 Elsevier Inc. All rights reserved.

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