経上腕動脈法による頸動脈ステント留置術の1例

Carotid Artery Stenting Using the Transbrachial Approach: Technical Case Report

Ⅰ．はじめに

　頸部頸動脈閉塞性病変に対するステント留置術の適用はますます広がりつつある．特に，内膜剥離術高危険群に対しては血管内治療の有効性が示された¹¹⁾．ステント留置術は，通常大腿動脈経由で行われるが，閉塞性動脈硬化症などの合併により施行できない場合がある¹⁰⁾．今回，われわれは右肘部上腕動脈経由による頸動脈ステント留置術を施行した．大腿動脈経由が困難な場合のアプローチに関して文献的考察を加えて報告する．

　We described a case of endoluminal stent placement for cervical internal carotid artery stenosis in which access was obtained via the proximal portion of the right radial artery. A 70-year-old man with a history of arteriosclerosis obliterans presented for endoluminal revascularization of a stenosed left internal carotid artery. The transfemoral approach was not possible because of severe atherosclerosis of the bilateral common iliac arteries. An approach was attempted via the right radial artery. After placement of a 6F short sheath in the proximal portion of the right radial artery, the guiding catheter was positioned in the left common carotid artery using the coaxial catheter system. Stenting was successfully performed under distal protection. This novel approach should be considered for endovascular procedures for which access to the carotid artery is limited.