VA occlusionで発症した破裂椎骨動脈解離性動脈瘤の1例

Ruptured Vertebral Artery Dissecting Aneurysm Presented with Vertebral Artery Occlusion:A Case Report

Ⅰ．はじめに

　椎骨動脈解離性動脈瘤（vertebral artery dissecting aneurysm：VADA）の血管撮影の所見としてはstring sign，pearl and string，aneurysmal dilatation，double lumen，occlusionなどがあるが，出血発症のVADAにおいて閉塞所見を呈することは稀である^4,8)．われわれは，発症時に閉塞を示した椎骨動脈が3日後に再開通した，posterior inferior cerebellar artery（PICA）-involved VADAの症例を経験した．本例では，再破裂の危険が高いと判断し，endovascular internal trappingを行った．文献的考察を加え報告する．

　We report a rare case of a ruptured vertebral artery dissecting aneurysm (VADA) with affected vertebral artery (VA) occlusion. A 66-year-old hypertensive man presented with subarachnoid hemorrhage. No cerebeller sign or cranial nerve palsy was found on admission. Initial CT angiography and digital subtraction angiography (DSA) revealed the right VA occlusion. On the three days after onset,the right VA was recanalized and visualized as a posterior inferior cerebellar artery (PICA)-involved VADA. Endovascular internal trapping of the right VA including PICA origin was performed. In conclusion,it is essential that patients of VA occlusion associated with subarachnoid hemorrhage should be carefully diagnosed considering the possibility of VADA.