Double overlapping stent techniqueにてflow diversionを行った紡錘状椎骨動脈瘤の1例

Flow Diversion by Double-overlapping-stent for Fusiform Vertebral Artery Aneurysm: A Case Report

Ⅰ．はじめに

　紡錘状椎骨動脈瘤では，母動脈閉塞が治療オプションとして選択されることが多いが，単純な母動脈閉塞では対処困難な症例も存在する．近年，欧米ではpipeline embolization device（PED，Chestnut Medical，USA）やSILK（Balt Extrusion，France）などのflow diversion専用デバイスの臨床応用が進み，良好な中期成績が報告されつつある^5,6,8,11)．今回，対側椎骨動脈に狭窄を伴う紡錘状椎骨動脈瘤に対して，double overlapping stent法にてflow diversionを行った1例を報告する．

　The authors present the case of a 61-year-old male with a de novo fusiform vertebral artery aneurysm, probably due to non-traumatic dissection. He underwent flow diversion therapy, using a double overlapping technique, because the origin of the contralateral vertebral artery was stenotic. Placement of two stents resulted in marked reduction of blood flow in the aneurysm. Postoperative course was uneventful. Follow-up 3D-CT angiography revealed a patent blood flow in the stent and a gradual progression of intra-aneurysmal thrombosis. Flow diversion therapy can potentially obliterate the complicated cerebral aneurysm with the preservation of blood flow in the parent artery, and would be one of the important therapeutic options in patients with complicated aneurysms in which conventional strategies such as neck clipping, endovascular coiling and parent artery occlusion are not feasible or contraindicated.