症候性亜急性期頸部内頸動脈ステント内血栓症の1例

A Case of Symptomatic Subacute In-stent Thrombosis after Carotid Angioplasty and Stenting for Severe Carotid Stenosis

Ⅰ．はじめに

　頸部内頸動脈ステント留置術（carotid angioplasty and stenting，CAS）後の亜急性期ステント内血栓症は比較的稀な合併症である．今回，われわれは頸部内頸動脈高度狭窄のCAS施行後に症候性亜急性期ステント内血栓症を合併し，緊急のステント内追加ステント留置による内頸動脈の血流改善と症状の著明な改善をみた症例を経験した．CAS施行の際の本合併症に対する対処を考える上で貴重な症例と考えられたので，若干の文献的考察を加えて報告する．

　We report a case of symptomatic subacute in-stent thrombosis after carotid artery angioplasty and stenting (CAS). The patient was a 72-year-old man who had severe asymptomatic right carotid artery stenosis. He received CAS with distal protection, and gained 100% opening of the right carotid artery. The administration of dual antiplatelet therapy (Aspirin100mg/day+Cilostazol100mg/day), which had been given since two weeks before the procedure, was continued afterwords. On the seventh day after the stent placement, the patient showed sudden onset of left hemiparesis and conjugated deviation of both eyes to the right side and followed by falling into a comatose state. Emergency angiography showed near occlusion of the right carotid artery, suggesting subacute in-stent thrombosis. In conjunction with the intravenous administration of tissue plasminogen activator (1300,000IU), we performed additional stent placement on the stented portion of the ICA and gained full recanalization of the ICA about three hours after the onset of the symptoms. The patient showed rapid recovery and returned home with slight clumsiness of his right hand.

　Symptomatic subacute in-stent thrombosis after CAS is a rather rare complication. We discuss on the possible cause of this and stress the necessity of an additional emergency stenting to gain rapid recanalization.