動脈造影法後にコレステロール塞栓症を合併し腎不全で死亡した1剖検例

An Autopsy Case of Renal Failure Due to Cholesterol Embolism Following Angiography

　症例は59歳男性．10年来の高血圧があり，左肩痛，上腕血圧の左右差（左＜右），左視野鼻側下野1／4欠損を主訴に入院．冠動脈と大動脈造影が実施され，左鎖骨下動脈の起始部閉塞を認めた．検査2週後に，左大腿動脈よりカテーテルを挿入し脳動脈のDSAが実施された．その後，左腓腹筋痛，blue toe，進行性腎不全をきたし3カ月後に死亡．剖検で腎臓はコレステロール塞栓に伴う不規則な皮質壊死巣を認めた．

　この症例は動脈造影の合併症としてのコレステロール塞栓症が，致死的な合併症になり得ることを示唆している．

A 59-year-old man with a 10-year history of hyper-tenison was admitted to the Osaka Medical College Hospital because of left shoulder pain, lower blood pressure in left arm, and nasal lower quadrant defect of the visual field of the left eye. After admission, he underwent coronary angiography and aortography. The examinations revealed that, although coronary arteries were normal, the orifice of the left subclavian artery was occluded almost completely. Two weeks after the examination, he underwent intra arterial DSA of the cerebral artery.