塞栓性頸動脈閉塞に対して単純吸引での血栓回収療法が奏効した1例

Successful Removal of Clots Embolic Carotid Occlusion by Aspiration with a Syringe : Case Report

はじめに

　塞栓性頸動脈閉塞に対するtissue plasminogen activator（t-PA）静注療法による再開通療法は，血栓量や血栓成分に影響を受け限界があり^1，2），内頸動脈急性閉塞に対する局所血栓溶解療法の有効性は低いと報告されている^1，3）。また，局所血栓溶解療法で溶解できたとしても末梢塞栓が起こりうる。近年，塞栓性頸動脈急性閉塞に対し血栓溶解薬を使用せず，カテーテルを使用した血栓回収療法が施行されるようになり，良好な結果が報告されている^4－7）。

　今回われわれは，塞栓性内頸動脈閉塞に対してバルーン付きガイドカテーテルを通して注射器で吸引するだけの単純な手技で血栓回収治療を施行し，良好な転帰を得ることができた症例を経験した。当科での経験と文献的な考察を加えて報告する。

Abstract

　An 84-year-old woman who had experienced a sudden onset of stupor and total aphasia and right-side hemiparesis was admitted to our institution.　Emergency MR (diffusion-weighted images: DWIs) studies revealed ischemic changes in the territory of the left middle cerebral artery; findings from the perfusion-weighted images (PWIs) has suggested a reduction of the cerebral blood flow.　In addition, the MR angiograms showed no signals in the left carotid-middle cerebral artery.　An emergency removal of the clot the carotid artery was attempted after an adaptive determination of revascularization was performed using MRI (DWIs/PWIs) during the acute stage.　An emergency cerebral angiography demonstrated occlusion of the left internal carotid artery (ICA).　In order to prevent the migration of thrombus into the peripheral arteries, the proximal blood flow was blocked using a 9-F guiding catheter with a coaxial balloon.　Manual aspiration through the catheter with a 10-ml syringe resulted in effective removal of the thrombus.　The thrombus was thus removed successfully, and the cerebral angiography after clot removal therapy (CRT) demonstrated complete recanalization of the left ICA.　The patient's National Institutes of Health Stroke score decreased from 25 to 1 at 8 days after clot removal and a good 3-month clinical outcome was achieved.　CRT by simple aspiration may be considered as a feasible and effective treatment modality for patients with embolic carotid occlusion.

Received: December 18, 2007, Accepted: June 4, 2008