Simultaneous Left Superficial Temporal Artery-Middle Cerebral Artery Bypass and Encephalodurovenosynangiosis for Progressive Atherosclerosis of the Left Internal Carotid Artery Communicating Segment.

Combined direct and indirect bypass have been described in the literature as a complementary technique.1 Direct superficial temporal artery-to-middle cerebral artery bypass is a cornerstone for adult moyamoya disease and syndrome as it provides immediate vascular supply.2 However, the donor vessel caliber and thus blood flow are subject to decrease over time, mainly due to new collateral formation.3 Encephaloduroarteriosynangiosis provides long-term blood supply and new collateral formation. We describe a case of progressive left internal carotid artery communicating segment atherosclerosis in a 34-year-old woman. An indirect bypass using the superficial temporal vein was chosen on the basis of absence of the left parietal branch of the superficial temporal artery.