ヨード過敏症を有する右鎖骨下動脈閉塞症例に対してガドリニウム造影剤を用いてステント治療を行った1例

Subclavian Artery Stenting Using Gadolinium Contrast Medium in a Case with Iodine Allergy

Ⅰ．はじめに

　Subclavian steal syndromeは鎖骨下動脈閉塞により上肢の血流が対側椎骨動脈から脳底動脈を介して逆供給され，上肢の運動とともに脳虚血症状や患側上肢の痛みが生じる疾患である．治療としては血管内治療を用いたステント留置術が低侵襲な治療法として確立しつつあるものの，患者がヨード禁忌症例であった場合に関しての治療法は言及されず，施設によっては椎骨動脈─鎖骨下動脈バイパスといった手術治療が選択されているかもしれない．

　一方で，2000年頃よりヨード過敏症例に対するGadolinium（Gd）造影剤を用いた血管造影や血管内治療が報告されるようになり，ヨード過敏症例への対策として知られてきた．今回われわれは，ヨード過敏症を有する鎖骨下動脈閉塞症例に対してGd造影剤を用いてステントを留置した1例を経験したので，治療の際の工夫なども含めて報告する．

　The authors reported a subclavian artery stenting (SAS) using gadolinium contrast medium. The patient was a 65-year-old female who presented dizziness and right upper extremity pain with movement. Digital subtraction angiography revealed right subclavian artery occlusion with subclavian steal phenomenon. We tried to treat this lesion using SAS. However,iodinated contrast medium caused the allergy in this patient and the treatment was discontinued. Therefore,SAS was performed with gadolinium contrast medium. Using gadolinium contrast medium,it is possible to confirm large arteries like innominate artery and subclavian artery. The stenting procedure was performed without complication.

　The usage of gadolinium contrast medium has the limit and some strategies are important to reduce the usage of gadolinium contrast medium in SAS. First, PercuSurge GuardWire^® was placed in the right internal carotid artery to confirm the anatomy, to decide working angle, and to treat the common carotid artery in case of dissection. Second, a “U” shaped guide wire was placed in the distal end from the brachial artery. Guide wire from femoral side was able to pass the lesion at midpoint of the “U” shaped one.

　SAS using gadolinium contrast medium may be an alternative treatment if a patient with subclavian artery stenosis or occlusion is allergic to iodinated contrast medium.