"Reverse" superficial temporal artery-middle cerebral artery bypass.

A new technical variant on the superficial temporal artery-middle cerebral artery anastomosis was performed in a patient with occlusions of both the left internal and external carotid arteries and persistent ischemic symptomatology. Instead of anastomosing the proximal segment of the superficial temporal artery to the middle cerebral artery as is conventionally done, the distal segment of the superficial temporal artery was anastomosed to a cortical branch of the left middle cerebral artery. Reconstituted flow of the left superficial temporal artery via right superficial temporal artery collateral branches proved adequate to relieve the patient's ischemic episodes. "Reverse" superficial temporal artery-middle cerebral artery anastomosis should be considered in those cases where occlusive disease of the external carotid circulation renders conventional bypass procedures ineffective in the treatment of ischemic symptomatology.