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Neurological Surgery No Shinkei Geka Volume 38, Issue 10 （October 2010）

Neurological Surgery 脳神経外科 38巻10号（2010年10月発行）

Japanese English

研究

頚部放射線照射後の頚動脈狭窄症に対するステント留置術 Carotid Artery Stenting for Radiation-induced Carotid Stenosis 江頭裕介 ¹ , 佐藤徹 ¹ , 桝田宏輔 ¹ , 大川将和 ¹ , 大西宏之 ¹ , 岡崎貴仁 ¹ , 高橋淳 ¹ , 村尾健一 ² , 飯原弘二 ¹ , 宮本享 ³ Yusuke EGASHIRA ¹ , Tetsu SATOW ¹ , Kosuke MASUDA ¹ , Masakazu OKAWA ¹ , Hiroyuki OHNISHI ¹ , Takahito OKAZAKI ¹ , Jun C TAKAHASHI ¹ , Ken-ichi MURAO ² , Koji IIHARA ¹ , Susumu MIYAMOTO ³ ¹国立循環器病研究センター脳神経外科 ²城山病院脳血管内治療科 ³京都大学脳神経外科 ¹Department of Neurosurgery,National Cerebral and Cardiovascular Center ²Department of Interventional Neuroradiology,Shiroyama Hospital ³Department of Neurosurgery,Kyoto University キーワード： carotid artery stenosis , radiation induced , stenting , unstable plaque , complication Keyword: carotid artery stenosis , radiation induced , stenting , unstable plaque , complication pp.913-920

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

DOI https://doi.org/10.11477/mf.1436101265

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Ⅰ．はじめに

　頚部放射線照射後の頚動脈狭窄症（radiation induced carotid stenosis：RI-CS）は，よく知られた合併症であり，現在ではステント留置術（carotid artery stenting：CAS）が治療の第一選択とされている．しかしながら，その治療成績については報告によってやや差異があり，いまだ統一された見解は得られていない．今回われわれは，自験例よりRI-CSにおける病変の特徴，治療成績について検討を行い，治療に際しての留意点について考察を加えた．

　Purpose and Methods: To evaluate the outcome and lesion characteristics in patients with radiation induced carotid stenoses (RI-CS) treated by carotid artery stenting (CAS), a total of five patients with RI-CS (six lesions) were retrospectively analyzed.

　Results: Four lesions had their most stenotic site at the common carotid artery (CCA). All cases had contralateral carotid or vertebral artery stenosis (＞50%). All patients had risk factors of atherosclerosis and all lesions contained unstable plaques at the stenotic site. A total of seven procedures were carried out and procedural success was obtained in all cases. Asymptomatic embolic infarctions associated with procedure were observed in four cases by diffusion-weighted MR imaging. In-stent thrombi were observed in two cases, one of which developed a neurological symptom three days after the procedure.

　Conclusion: CAS is a technically successful intervention for RI-CS. Care should be taken according to the characteristics of the plaque, which usually is vulnerable and long. Appropriate choice of a protection method could help in the reduction of unfavorable embolic complications and close postoperative follow up is mandatory.