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Neurological Surgery No Shinkei Geka Volume 38, Issue 1 （January 2010）

Neurological Surgery 脳神経外科 38巻1号（2010年1月発行）

Japanese English

症例

無名動脈狭窄症に対する経皮的血管形成術により記憶障害が改善した1例 Percutaneous Transluminal Angioplasty for Memory Disturbance Caused by Stenosis of the Innominate Artery 根木宏明 ¹ , 石原正一郎 ¹ , 石原秀章 ¹ , 金澤隆三郎 ¹ , 神山信也 ¹ , 山根文孝 ¹ , 大沢愛子 ² , 前島伸一郎 ² Hiroaki NEKI ¹ , Shoichiro ISHIHARA ¹ , Hideaki ISHIHARA ¹ , Ryuzaburou KANAZAWA ¹ , Shinya KOHYAMA ¹ , Fumitaka YAMANE ¹ , Aiko OOSAWA ² , Shinichirou MAESHIMA ² ¹埼玉医科大学国際医療センター脳卒中センター脳血管内治療科 ²埼玉医科大学国際医療センターリハビリテーション科 ¹Division of Endovascular Neurosurgery,Stroke Center,Saitama Medical University International Medical Center ²Divion of Rehabilitation,Saitama Medical University International Medical Center キーワード： stenosis , innominate artery , PTA (perctaneous transluminal angioplasty) , memory disturbance , cognitive impairment Keyword: stenosis , innominate artery , PTA (perctaneous transluminal angioplasty) , memory disturbance , cognitive impairment pp.73-78

発行日 2010年1月10日 Published Date 2010/1/10

DOI https://doi.org/10.11477/mf.1436101096

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参考文献 Reference

Ⅰ．はじめに

　無名動脈の狭窄においては，鎖骨下動脈・総頚動脈両者の血流低下が生じる．鎖骨下動脈の血流低下では，鎖骨下動脈盗血症候群が有名で，鎖骨下動脈に狭窄を呈した際，疎血状態となった患側椎骨動脈，上腕動脈の血流を確保するために対側椎骨動脈の血流が患側を逆流して供給される血行動態となる．症状としては，椎骨動脈の虚血に起因する眩暈・眼症状・不安定感・失神・後頚部痛などや，上腕動脈の阻血に起因する易疲労感・脱力・冷感・しびれ・血圧左右差などが知られている．無名動脈に狭窄を来した場合にも同様の症状を来すことが知られている²⁾が，われわれが検索した限り，高次脳機能障害に関する報告は少ない．今回われわれは，記憶障害を主症状とした無名動脈狭窄症に対して経皮的血管形成術（PTA：percutaneous transluminal angioplasty）を施行し，症状の改善が得られた1例を経験したので報告する．

　It is well known that significant narrowing of the subclavian or innominate artery may cause cerebrovascular ischemic symptoms. We report a case of a 62-year-old man who was suffering from progressive cognitive impairment and was treated by perctaneous transluminal angioplasty (PTA). The patient had undergone aorto-bifemoral bypass,left femoropopliteal bypass,and right femoral artery endoarterectomy. On admission,he was alert,but had memory impairment,especially delayed recall. He complained of dizziness and dysesthesia on his right upper extremity which got worse on exertion. The right radial pulse was diminished and the right brachial blood pressure was lower about 40mmHg than the left. Angiography demonstrated severe stenosis of the innominate artery near its origin,hypoplasty of the left horizontal anterior cerebral artery segment (A1),and dilation of the left external carotid artery. Left vertebral arteriography revealed retrograde flow of the right vertebral artery in the late arterial phase. Single photon emission computed tomography (SPECT) revealed marked reduction in cerebral blood flow to the left frontal lobe. The patient underwent PTA of the innominate artery with satisfactory results. Cognitive impairment improved remarkably after the angioplasty. The right radial pulse was quite palpable,and the bilateral brachial blood pressures were the same. The cerebral blood flow was increased in SPECT. Memory disturbance can be generated by stenosis of the innominate artery. PTA is one of the effective methods to reverse such cognitive impairment.