肺動静脈瘻のコイル塞栓術後に脳塞栓を発症した1例

A Case of Cerebral Embolism after Embolotherapy of Pulmonary Arteriovenous Fistula

要旨　患者は72歳，女性．50歳の時，脳膿瘍で開頭術を受けていたが，原因検索は行われていなかった．最近，脳外科を受診時，太鼓バチ指，口唇・爪床のチアノーゼを指摘され当科へ紹介された．精査にて多発性肺動静脈瘻と診断．動静脈瘻は右下肺野に3個，左下肺野に2個の計5個認められた．コイル塞栓術の適応と考え，右肺動静脈瘻に対してinterlocking detachable coil(IDC)を合計26本留置して塞栓した．留置後の血管造影で動静脈瘻への血流は遮断されたと判断した．術後16時間以内に3回の痙攣発作を生じ，術24時間後の脳MRIにて多発性に微小脳梗塞を認め，microembolismによるものと考えられた．後遺症を認めなかったが，コイル塞栓術による稀な合併症と判断した．

　We report a case of a 72-year-old woman with multiple pulmonary arteriovenous fistulas(PAVF). She had a history of a previous brain abscess in the right cerebellar hemisphere. A chest X-ray and CT showed several nodular lesions in both the right and left lower region. Pulmonary angiograms also revealed multiple PAVF in the lower lobe of both the lungs, and were helpful for showing a feeding artery and vein. The fistulas of the right lung were embolized with coils via a percutaneous catheter. There was remarkable improvement in the patients' hypoxemia. Embolotherapy was an effective procedure for treatment of multiple high shunt PAVF. However the patients experienced convulsions several times within 16 hours after embolization. MRI of the brain showed multiple high density areas that were considered to be microembolisms. Though coil embolization is suggested as the first choice of treatment, it should be carefully performed to prevent complications.