Covered Stentを用いて治療を行った対側に高度狭窄病変を伴う頚部巨大仮性動脈瘤の1例

A Case of a Giant Cervical Carotid Artery Aneurysm with Contralateral Severe Stenosis Treated Using a Covered Stent

Ⅰ．はじめに

　頚部仮性動脈瘤は稀な疾患であり，動脈瘤による局所圧迫症状や瘤内血栓による虚血症状で発症する．治療は直達手術が一般的であるが，近年血管内手術の手技を用いた治療報告も散見されている．今回われわれは，対側の内頚動脈に高度狭窄を合併した高位の頚部巨大仮性動脈瘤に，covered stentを用いた治療を行った症例を経験したので報告する．

　We report a case of a cervical carotid artery pseudoaneurysm with contralateral severe stenosis,treated using a covered stent. A 79-year-old man admitted for a splenic artery aneurysm presented a pulsatile mass on the right side of his neck and lower cranial nerve palsy after misinsertion of a central venous line into the right carotid artery. MRI revealed a huge thrombosed aneurysm (30 mm×25 mm) in the right common carotid artery (CCA). We planned an aneurysmectomy and CCA interposition with a vascular graft. However the aneurysm continued to expand. We considered that it was difficult to expose the internal carotid artery (ICA) by a direct surgical technique,and therefore carried out placement of a covered stent over the orifice of the aneurysm using an endovascular surgical technique. Following placement of the covered stent,subsequent contrast-enhanced CT revealed leakage of contrast material into the aneurysm. An additional bare stent was placed into the proximal end of the covered stent at 15 days after the initial treatment. Angiography demonstrated no leakage of the contrast material. Following the second treatment,the pulsatile mass was reduced in size. Lower cranial nerve palsy remained but had slightly improved.

　We described the case of a huge cervical carotid pseudoaneurysm that was successfully treated using a covered stent.