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September 5, 2026Journal of Cerebrovascular and Endovascular NeurosurgeryOpen Access

Postoperative posterior MCA territory infarction following single-barrel STA-MCA bypass with hemodynamic territory mismatch in moyamoya disease: A case report

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Authors

MWMin Seok WooMKMyungsoo Kim

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Overview

Case report demonstrates acute posterior MCA infarction in moyamoya disease due to territory mismatch, highlighting the need for perfusion-guided revascularization.

Key Points

  • To report a case of acute cerebral infarction following single-barrel STA-MCA bypass in moyamoya disease caused by a mismatch between revascularized and ischemic territories.
  • Evaluated a 47-year-old woman with bilateral moyamoya disease and progressive left hemiparesis using digital subtraction angiography and computed tomography perfusion.
  • Performed a right single-barrel frontal STA-to-temporal M4 bypass combined with encephalo-duro-arterio-synangiosis, verifying intraoperative patency using indocyanine green videoangiography.
  • Despite confirmed bypass patency, acute cerebral infarction developed on postoperative day 1 within the right posterior middle cerebral artery territory, which was the most ischemic area preoperatively.
  • Follow-up angiography at 2 months demonstrated sustained bypass patency and regression of deep choroidal periventricular anastomoses.

Cite This Study

Woo et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd4726b95aff0620ec318https://doi.org/10.7461/jcen.2026.e2026.06.007
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy of a Modified Superficial Temporal Artery–Middle Cerebral Artery Bypass Using Superficial Temporal Artery Side-Branch Donors in Adult Moyamoya Disease: A Technical Note2025
  2. 2Superficial Temporal Artery to Middle Cerebral Artery (STA-MCA) bypass: How I do it2026 · 1 citations
  3. 3Symptomatic cerebral hyperperfusion after occipital artery–posterior cerebral artery bypass in a patient with moyamoya disease: illustrative case2025
  4. 4A ruptured de novo anastomotic aneurysm shortly after superficial temporal artery–to–middle cerebral artery bypass surgery in a patient with moyamoya disease: illustrative case2025
  5. 5Salvage Occipital Artery–Middle Cerebral Artery Bypass for Refractory Moyamoya Disease: Systematic Review and Illustrative Case of Bilateral Revascularization2026