Acute parent artery occlusion in thrombosed middle cerebral artery aneurysm presenting with ischemic stroke

Abstract Background Thrombosed intracranial aneurysms are complex and unstable lesions, which are especially associated with ischemic stroke. Although acute parent artery occlusion presenting with ischemic stroke is very rare, it can lead to catastrophic consequences. Case description This study presents two cases of acute parent artery occlusion in thrombosed large and giant middle cerebral artery (MCA) bifurcation aneurysms presenting with ischemic stroke that were successfully treated with emergent double-barrel superficial temporal artery (STA)-MCA bypass followed by aneurysm trapping. Conclusions Emergent STA-MCA bypass could be a salvageable treatment option in patients with progressive neurologic deficits and significant mismatch between diffusion-(DWI) and perfusion- (PWI) weighted imaging in acute parent artery occlusions associated with large or giant thrombosed aneurysms. Besides DWI and PWI, preoperative assessment of the collaterals will help in predicting postoperative prognosis.