Internal trapping後に再発した破裂椎骨動脈解離性動脈瘤の1例

A Case of a Ruptured Vertebral Artery Dissecting Aneurysm Recanalized after Internal Trapping

Ⅰ．はじめに

　破裂椎骨動脈解離性動脈瘤（vertebral artery dissecting aneurysm：VADA）は初回破裂後24時間以内に高率に再出血を来すことから，超急性期の外科的治療が強く望まれる疾患である^10,13,14)．超急性期に低侵襲で再破裂予防処置を行えることから，VADAに対する血管内治療は近年広く応用されるようになってきた^3,5,10-15)．今回われわれは，破裂VADAに対しコイルによるinternal trapping ^5,13-15)を施行し完全閉塞が得られていたにもかかわらず，その経過観察中に順行性の再開通・増大を来した1例を経験したので，文献的考察を加えて報告する．

　A 35-year-old male experienced a sudden onset of severe headache. A CT scan revealed subarachnoid hemorrhage. By cerebral angiography, he was diagnosed as having a ruptured right vertebral artery dissecting aneurysm (VADA). It was successfully treated by endovascular occlusion of the affected site, including the aneurysm and parent artery, by using detachable coils. A follow-up angiography obtained seven months after the first treatment revealed the recanalization of the right vertebral artery and dissected aneurysm in an antegrade fashion. A skull X-ray image was useful for detecting the change in appearance of the coils. The second embolization was successfully performed in the same manner. Based on this rare case, the authors emphasize that a careful angiographic analysis and complete internal trapping of the dissecting site are important in the treatment of the ruptured VADA.