脳幹梗塞で発見された左鎖骨下-椎骨動脈分岐部動脈瘤の1例

A Case of a Subclavian-Vertebral Junction Arterial Aneurysm with Brain Stem Thromboembolism

　Ⅰ．はじめに

鎖骨下動脈瘤の報告は散見されるが，多くは胸部血管外科医による動脈瘤摘出術成功例^1,3-6,8,9)のものである．この症例は脳梗塞で発症したため，脳神経外科病棟に入院された患者であり，瘤内コイル塞栓術により良好な結果が得られたので報告する．

　Subclavian artery aneurysm is relatively rare,but,we can scarcely find mention in the literature of a subclavian-vertebral junction aneurysm. We report a case of a 73-year-old man with a left subclavian-vertebral junction arterial aneurysm of 11 mm in diameter which caused a brain stem thromboembolism. He showed right hemiparesis and dysarthria on admission. On the 5th day after admission,his hemiparesis worsened and he could not even walk. In order to prevent further embolic attack on the vertebro-basilar system and rupture from the aneurysm,we embolized the aneurysm successfully with some GDC coils. During the operation,no further brain infarction occurred,and we maintained blood circulation in the left subclavian-vertebral artery. This aneurysm appeared on angiography to be atherosclerotic in its clinical characteristics,and we have scheduled follow-up angiography in two years time. As his hemiparesis had improved,he was discharged from the hospital on foot.