Bovine archに対する経上腕動脈法の頸動脈stent留置術の1例

A Case of Carotid Stenting via the Transbrachial Approach in the Bovine Arch

Ⅰ．は じ め に

　近年，器材の進歩に伴い，頸動脈stent留置術の治療成績が確実に向上してきた．本邦でも，6Fr以下のstentが入手可能となり，従来の経大腿動脈法では総頸動脈へのcatheter挿入が困難な症例では，経上腕動脈法も考慮できるようになった．特に，右腕頭動脈より左総頸動脈が分岐しているいわゆるbovine archの症例では，経右上腕動脈法の方が左総頸動脈へcatheterを誘導しやすいことが多いが⁶⁾，本邦での経上腕動脈法の頸動脈stent留置術の報告例はまだない．今回われわれは，bovine archを伴った左頸部内頸動脈狭窄の症例に対し，6Fr Shuttle sheath（Cook）と6Fr Precise stent（Cordis）を用いた経右上腕動脈法の左頸動脈stent留置術を経験したので報告する．

We report our experience in carotid stenting via the transbrachial approach in patients with anomalous origin of the left common carotid artery,the so-called bovine arch,in which both the right common carotid artery and the left common carotid artery arise from the brachiocephalic artery. Via percutaneous access to the right brachial artery,a 6Fr Shuttle sheath is advanced into the aortic arch to cannulate the left common carotid artery. A Guardwire distal-protection balloon is positioned within the left internal carotid artery distal to the stenosis. The lesion is dilated,followed by satisfactory deployment and dilation of a 6Fr Precise stent. Carotid stenting via the brachial artery in bovine arch appears feasible as an alternative to standard femoral access.