硬膜外内頸動脈の症候性多発性狭窄症に対し近位部結紮術を施行した1例

Proximal Ligation of the Parent Artery for Symptomatic Tandem Stenosis of the Extradural Internal Carotid Artery : A Case Report

Ⅰ．はじめに

　錐体部から海綿静脈洞部の硬膜外内頸動脈における症候性狭窄症に対しては，薬物治療が第一の選択となる．一方，薬物抵抗性の同病変に対しては血行再建術が必要となるが，直達による観血的血行再建術は不可能であり，近年ではステントを用いた経皮的血管形成術（percutaneous transluminal angioplasty：PTA）が試みられている^1,12)．しかし，病変部の性状によっては血管解離や血管破裂，プラーク飛散といった重篤な合併症が起こり，本法にも限界がある¹¹⁾．

　今回われわれは，頸部から錐体部・海面静脈洞部の硬膜外内頸動脈の薬物抵抗性症候性多発性狭窄症に対して，親動脈結紮術を施行した症例を経験したので報告する．

　A 72-year-old man suffered blindness due to right central retinal artery occlusion. Cerebral angiography revealed tandem stenosis in the cervical, petrosal and cavernous portions of the right internal carotid artery (ICA). Blood flow from the vertebrobasilar artery via the right posterior communicating artery mainly perfused the right cerebral hemisphere. In addition, significant stenosis was observed in the left cervical carotid artery and the origin of the left vertebral artety. First, the patient underwent left carotid endarterectomy and vertebral artery to subclavian artery transposition. Two months later, ligation of the right ICA at its origin was performed. Postoperative course was uneventful and the patient has not experienced further ischemic events. We suggest that proximal ligation of the parent artery is a useful procedure for medically-refractory extradural ICA stenosis when surgical direct revascularization and percutaneous transluminal angioplasty cannot be performed.