LAUSR

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