Division of Neurology, National University Health System, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Br J Neurosurg. 2020 Dec;34(6):626-627. doi: 10.1080/02688697.2019.1645299. Epub 2019 Jul 26.
Intracranial arterial stenosis is a common cause of ischemic stroke. Recent attempts with intracranial stenting and superficial temporal-middle cerebral artery (STA-MCA) bypass failed to show benefit. Perhaps, better strategies are needed for selecting suitable patients. Acetazolamide-challenged single photon emission computed tomography (SPECT) can demonstrate reversed Robin Hood syndrome (RRHS) due to intracranial steal phenomenon and identify high-risk patients. We describe the clinical and SPECT findings of RRHS. In our patient with severe and symptomatic severe stenosis of the right MCA, STA-MCA bypass resulted in complete resolution of RRHS. STA-MCA bypass surgery should be considered a possible option in patients with severe stenosis of intracranial internal carotid artery or MCA in carefully selected patients.
颅内动脉狭窄是缺血性脑卒中的常见原因。最近颅内支架置入术和颞浅动脉-大脑中动脉（STA-MCA）搭桥术的尝试未能显示出获益。也许，需要更好的策略来选择合适的患者。乙酰唑胺挑战单光子发射计算机断层扫描（SPECT）可以显示由于颅内盗血现象导致的反向罗宾汉综合征（RRHS），并识别高危患者。我们描述了 RRHS 的临床和 SPECT 发现。在我们的患者中，右侧 MCA 严重且有症状的狭窄，STA-MCA 搭桥术导致 RRHS 完全缓解。在仔细选择的患者中，对于颅内颈内动脉或 MCA 严重狭窄的患者，STA-MCA 搭桥手术应被视为一种可能的选择。
