Recombinant
tissue-type plasminogen activator with/without endovascular regimen is sometimes not effective for the treatment of acute hemodynamic
stroke. Emergent superficial temporal artery-middle cerebral artery (
STA-MCA) bypass has been reportedly effective in patients with progressive hemodynamic
stroke; however, the effectiveness of urgent
STA-MCA bypass for acute internal carotid artery (ICA)
stenosis/occlusion with concomitant contralateral chronic ICA
stenosis/occlusion, that is considered the worst hemodynamic situations, is unclear. Two cases of acute left ICA
stenosis with concomitant right chronic ICA occlusion wherein both developed hemodynamic
infarction and were initially treated by maximal medical treatment. Nevertheless, the patients' symptoms had gradually worsened, thus we performed emergency
STA-MCA bypass for both cases. Postoperatively, deterioration of imaging and neurological findings was successfully stopped and the patients' condition gradually stabilized. An urgent
STA-MCA bypass can be considered as a last resort to prevent progressive neurological deterioration for patients with progressive
infarction due to ICA
stenosis/occlusion concomitant with contralateral ICA
stenosis/occlusion.