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要旨 脳血管における窓形成(fenestration)の多くは椎骨脳底動脈系で,内頸動脈(ICA)での報告は非常に少ない。解離性動脈瘤を疑われて検査を行った結果,窓形成と判明した2例を新たに経験した。症例1:55歳男性,右頸部痛と拍動性の腫瘤で受診,MR angiography(MRA)で頭蓋外のICAにdouble lumenが疑われた。脳血管撮影とCT angiographyで,C2/3椎体レベルで完全に分離したほぼ同じ径の血管腔が明らかになった。症例2:52歳男性,入浴後から左顔面の疼痛と視力障害,嘔気嘔吐にて受診。MRAで解離性動脈瘤が疑われた。画像診断でC1/2レベルに窓形成が確認された。窓形成は偶然みつかるもので,ほとんどの例は無症候である。窓形成の画像所見と鑑別を要する疾患について文献的考察を交えて報告する。
Fenestration of the internal carotid artery(ICA)is extremely rare on clinical settings. Six cases of fenestration in intracranial and 8 in extracracranial ICA have ever been reported in literature. Authors describe two cases of fenestration at the extracranial ICA that were initially suspected of the dissection of ICA on MRA/I. Both angiography and CT angiography(CTA)disclosed the fenestration, which located at C2 vertebral levels. To confirm the fenestration at extracranial ICA is important in such an occasion that mimick the dissection of ICA, especially in patients who complain of cervical pain, mass and other related symptoms. Differences in the fenestration, the dissection and atherosclerosis on imaging, were reviewed and discussed.
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