Rescue Extracranial-Intracranial Bypass for Ischemic Stroke Secondary to Progressive Human Immunodeficiency Virus-Associated Vasculopathy.

Abstract

BACKGROUND:

 Human immunodeficiency virus (HIV) associated vasculopathy can cause ischemic cerebral stroke; however, there is limited evidence on optimal management. Herein, we report a case of acute ischemic stroke due to progressive internal carotid artery (ICA) stenosis in an HIV-positive patient. Superficial temporal artery to middle cerebral artery (STA-MCA) bypass, in addition to the best medical treatments, prevented stroke progression.

CLINICAL DESCRIPTION:

 A 39-year-old man with HIV infection presented with a sudden onset of aphasia and right hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the left basal ganglia and concentric thickening of the vessel wall in the terminal portion of the bilateral ICAs. Despite maximal medical treatments for HIV-associated vasculopathy and possible opportunistic infections, bilateral ICA stenoses progressed, leading to a second hemodynamic stroke event. Because tissue plasminogen activator treatment failed, we performed STA-MCA bypass. A significant improvement in neurologic symptoms and cerebral blood flow was observed after surgery. No further stroke events occurred during the continuation of medical treatments.

CONCLUSION:

 This is the first case of STA-MCA bypass performed in a patient with recurrent ischemic stroke caused by HIV-associated vasculopathy. Although further evidence is needed, such treatment options can shed new light on the management of progressive HIV-associated vasculopathy, which is refractory to maximal medical treatment.

• Authors: Makoto Mizushima, Taku Sugiyama, Katsuki Eguchi, Monami Tarisawa, Kikutaro Tokairin, Masaki Ito, Daigo Hashimoto, Ichiro Yabe, Miki Fujimura
• Journal: Journal of neurological surgery. Part A, Central European neurosurgery (J Neurol Surg A Cent Eur Neurosurg) Vol. 85 Issue 1 Pg. 88-93 (Jan 2024) ISSN: 2193-6323 [Electronic] Germany
• PMID: 35193153 (Publication Type: Case Reports, Journal Article)
• Copyright: Thieme. All rights reserved.

Chemical References

• Tissue Plasminogen Activator

Topics

• Male
• Humans
• Adult
• Tissue Plasminogen Activator
• Ischemic Stroke
• HIV
• HIV Infections (complications)
• Middle Cerebral Artery (diagnostic imaging, surgery)
• Stroke (diagnostic imaging, etiology, surgery)
• Carotid Stenosis (surgery)
• Cerebral Revascularization (methods)