Superficial temporal artery-middle cerebral artery bypass for carotid stent thrombosis: two case reports and literature review

Abstract Background Carotid stent thrombosis (CST) is a rare but devastating complication after carotid artery stenting (CAS). However, treatment strategy for CST remains controversial. Case presentation Case 1 was a 66-year-old man treated with scheduled CAS using a dual-layer stent for symptomatic internal carotid artery stenosis and developed CST 2–5 days after intervention, causing repeated transient ischemic attacks 2 months later. Case 2 was a 69-year-old man initially treated with emergent CAS using a closed-cell stent for acute ischemic stroke and developed CST with minor stroke six months after CAS. Both patients had impaired cerebrovascular reserve (CVR) on single-photon emission computed tomography. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass was performed with no procedural complications, and ischemic stroke has not recurred for subsequent 2 years and 4 years, respectively. Conclusion STA-MCA bypass may be beneficial to CST with mild neurological symptoms and impaired CVR, which occurs in subacute to chronic phases after CAS: the bypass could reduce the risks of distal embolization, damage to carotid artery and stent, and reperfusion injury.