破裂脳底動脈解離性動脈瘤に対してflow reverseにより治療し得た1例

Flow Reverse Therapy for Ruptured Dissecting Aneurysm of Basilar Trunk： Case Report

Ⅰ．はじめに

　脳底動脈解離性脳動脈瘤（以下，BADAN）に対する有効な治療法はいまだ確立されていないのが現状である．今回われわれは，BADANに対し両側椎骨動脈（以下，VA）を閉塞することにより脳底動脈（以下，BA）の血流を逆流せしめること（flow reverse）で治療し得た1例を経験したので文献的に考察し報告する．

Treatment of ruptured dissecting aneurysm of basilar trunk (BADAN) has been controversial yet. We report a case of ruptured BADAN successfully treated with endovascular occlusion of the bilateral vertebral artery(VA) proximal to posterior inferior cerebellar artery (PICA), allowing retrograde flow via the posterior communicating arteries to basilar artery. A 58-year-old woman who had subarachnoid hemorrhage was treated with endovascular occlusion of the right VA in acute stage after ballon occlusion test (BOT) of the right VA. Because following BOT of the left VA showed conscious level down, left VA could not be occluded. Follow-up angiography after 26 days revealed regrowth of BADAN. So left VA occlusion was tolerable by BOT after 1 month, we performed endovascular occlusion of the left VA proximal to PICA. She discharged with no neurological deficit after 3 months. Postoperative angiograms 3 months after onset showed complete healing of the aneurysm. The follow-up MRA at 19 months showed no recurrence. We discussed the therapeutic strategy of ruptured BADAN. Flow reverse therapy of bilateral VA occlusion by endovascular method for ruptured BADAN is one of the effective therapy.