• Eric Schmidt, Lindsey Parker, and Justin F Fraser.
• College of Medicine, University of Kentucky, Lexington, Kentucky, USA.
• BMJ Case Rep. 2014 Aug 1; 2014: bcr-2014-011328.

BackgroundMoyamoya disease is characterized by progressive narrowing of the internal carotid artery (ICA). Symptomatic patients typically undergo cerebrovascular intervention via extracranial-intracranial (EC-IC) bypass, most often with the use of the superficial temporal artery. This case of Moyamoya disease is of particular interest as the patient presented with a unilateral atherosclerotic external carotid artery (ECA) stenosis after EC-IC bypass that eliminated the benefit of his original surgery, resulting in a symptomatic presentation.Clinical PresentationA 53-year-old man presenting with Moyamoya disease and known left ICA occlusion had received a bilateral encephaloduroarteriosynangiosis (EDAS) bypass 10 years previously. He re-presented complaining of right-sided tingling, weakness, and numbness radiating up the arm. CT angiography indicated significant stenosis of the left ECA. ECA angioplasty and stenting with a distal protection device resulted in resolution of his symptoms.ConclusionsThis case illustrates that a patient presenting with Moyamoya disease and concurrent symptomatic ECA stenosis post-EDAS can be effectively and safely treated with ECA stenting.2014 BMJ Publishing Group Ltd.

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