脳塞栓症を呈した左房粘液腫—超選択的血栓溶解術が奏効した1例

A Case of Cerebral Embolism Caused by Atrial Myxoma: Superselective fibrinolytic therapy

I．はじめに

　心筋梗塞に対して選択的に血栓溶解剤を注入し，早期に冠動脈を再開通させる冠状動脈血栓融解療法（Percutaneous Transluminal Coronary Recanalization；　PTCR）はGanz^6）らにより試みられ，広く普及している．

　一方，頭蓋内脳血管に対しては，Zeumer^24）らの報告以外には超選択的に血栓溶解剤を注入し成功した報告はみられない．

A 37-year-old man was admitted to our clinic 3 hours after the onset of cerebrovascular accident with right hemiparesis and total aphasia.

On admission, we started combined administration of mannitol, vitamin E, phenytoin (Sendai Cocktail) and perfluorochemicals to protect ischemic brain.

Left cerebral angiography revealed occlusion of the left middle cerebral artery involving its perforating arteries. Following the performance of angiography, vascular balloon catheter was introduced into the embo-lus, and fibrinolytic agent (urokinase) was continuously injected.