ステント留置時の血流遮断に不耐性であり，治療後に再々狭窄を来した頸部内頸動脈狭窄症の1例

A Case of Carotid Occlusive Disease Treated with Stenting for Recurrence of Stenosis: Strategy on Intolerance to Temporary Occlusion

Ⅰ．はじめに

　頸部頸動脈閉塞性病変に対するステント留置術はますます広がりつつある．特に内膜剝離術高危険群に対しては血管内治療の有効性が示された¹⁵⁾．本邦では術中に生じるデブリスによる脳塞栓症を予防するためにバルーンによる血流遮断が行われているが，稀に血流遮断により一過性の麻痺や意識障害を来すことがある⁴⁾．また，頸動脈病変においてもステント留置後に再狭窄を来すことがある^5,7,10)．今回，われわれは血流遮断に不耐性であり，再狭窄を繰り返した内頸動脈狭窄症の1例を経験した．血流遮断不耐性への対策と再狭窄の病態について文献的考察を加えて報告する．

　Carotid artery stenting has emerged as an acceptable treatment alternative in patient with occlusive carotid bifurcation disease. High-risk surgical candidates have a lower rate of morbidity after carotid artery stenting with distal embolic protection. Among distal protection devices,a Guardwire balloon occlusion is the most frequently employed in Japan. A 79-year-old male who had severe stenosis at the origin of left carotid artery was treated with stenting under Guardwire balloon protection. He was intolerant to carotid artery occlusion and endovascular procedures were performed under intravenous anesthesia or general anesthesia. In addition,he suffered recurrent stenosis seven months after the first procedure and 16 months after second procedure,and underwent repeated intervention. It was considered that the long tortuous lesion was a cause of the recurrent stenosis.