SAHで発症した両側椎骨解離性動脈瘤の1例

A Case of Spontaneous Bilateral VA Dissecting Aneurysm Presenting with SAH

Ⅰ．はじめに

　近年，椎骨解離性動脈瘤はstrokeの原因として，特に本邦において報告が増加している¹³⁾．出血発症の場合は高率に再出血を来すといわれており，早期診断，早期治療が求められる¹³⁾．治療としてはtrapping，proximal occlusion（clipping or coil embolization）が行われるが，両側椎骨の解離では出血側の診断，対側病変の治療においていくつかの問題が生じてくる．

　今回，当院にて治療された出血発症両側椎骨解離性動脈瘤の1例について報告する．

　We report a case of bilateral vertebral artery (VA) dissecting aneurysm presenting with subarachnoid hemorrhage (SAH). It was difficult to decide which side was responsible for SAH because the patient's symptom and head CT suggested that the left VA aneurysm had ruptured, but angiography and MRA showed an irregular pearl and string sign on the right side. He was successfully treated by trapping of the right VA dissecting aneurysm and we confirmed by intraoperative evaluation that the right VA dissecting aneurysm had ruptured. The left unruptured aneurysm decreased its size spontaneously. In the treatment of the bilateral VA dissecting aneurysms, angiography needs to be performed over and over again because contralateral unruptured aneurysm may grow or rupture due to increased hemodynamic stress. Various combinations of direct sugery with or without arterial reconstruction and endovascular treatment should be considered when treating bilateral VA dissecting aneurysms.