椎骨動脈血栓症に伴う脳底動脈塞栓症3例の血管内治療経験

Basilar Artery Occlusion Due to Embolism from the Vertebral Artery: Three Case Reports

Ⅰ．はじめに

　脳底動脈塞栓症は，早期の再開通が得られなければ，非常に予後が悪いことが知られている^2-5)．塞栓源は主に心原性塞栓のほか，椎骨動脈など主幹動脈からの血栓塞栓である．特に椎骨動脈起始部は狭窄性病変の好発部位であり，脳底動脈塞栓症の血管内治療に際し，病変部までのアプローチを困難にさせるだけでなく，主たる塞栓源となっていることにも注意して治療を行わなければならない⁷⁾．

　今回，われわれは椎骨動脈起始部に生じた血栓塞栓による脳底動脈塞栓症に対する血管内治療を行った3症例を提示し，その問題点について検討した．

　Without early recanalization,it is well known that acute basilar artery occlusion almost always results in death or severe disability. We report three cases of basilar artery occlusion due to vertebral artery thrombo-embolism. In all cases,the cause of the strokes was artery to artery embolism from the vertebral artery origin. In case 1 and 3,despite complete occlusion of the vertebral artery origin,the thrombus was drained into the basilar artery through collateral flow from the external carotid artery.

　Atherosclerotic lesion of the vertebral artery origin is one of the main embolic sources of basilar artery,in which case,angioplasty or stent placement of the vertebral artery origin should be considered in addition to thrombolysis of the basilar artery.