後下小脳動脈を含んだ破裂椎骨動脈解離に対し，ステントを用いた二期的コイル塞栓術により後下小脳動脈を温存した1例

Stent-Assisted Embolization for Ruptured Vertebral Artery Dissection Involving the Origin of the Posterior Inferior Cerebellar Artery:A Case Report of Staged Strategy

Ⅰ．はじめに

　後下小脳動脈（posterior inferior cerebellar artery：PICA）起始部を含んだ破裂椎骨動脈解離（PICA involved ruptured vertebral artery dissection：Pi-rVAD）の治療法には直達手術と血管内治療があり，その中でもいくつものバリエーションが存在する．また最近ではステントを用いた血管内治療の報告がなされている．今回われわれは，発達したPICA起始部を含んだ破裂VADに対して，初回治療でPICA分岐後のより不整に拡張し，破裂部と考えられた椎骨動脈（vertebral artery：VA）遠位部に対してコイルによるinternal trapping（IT）を行い，破裂急性期を脱した後に十分な抗血栓療法下にPICAから近位VAにかけてEnterprise vascular reconstruction device（Enterprise VRD；Codman Neuroendovascular, Johnson ＆ Johnson, Miami, FL, USA）を用いて近位VA拡張部を塞栓し，PICAを温存できた症例を経験したので報告する．

　We report a ruptured vertebral artery dissection（VAD）involving the origin of the posterior inferior cerebellar artery（PICA）treated by a staged strategy with stent-assisted coil embolization. A 52-year-old woman was admitted with a ruptured right VAD involving the origin of the developed PICA. Endovascular internal trapping of the enlarged distal VAD was performed（Stage 1). After 1 month, following confirmation of platelet inhabitation（Stage 2）an Enterprise stent（Cordis Neurovascular, Miami Lakes, FL）placement from the PICA to the proximal VA with coil embolization for proximal VAD was performed under dual antiplatelet therapy. The dissected VA segment was occluded by coil embolization and the PICA was preserved. Advantages of this staged treatment are the avoidance of ischemic/hemorrhagic complications due to antithrombotic therapy when stent placement to the PICA is planned during the acute stage of SAH and confirmation of platelet inhabitation before stent placement in second treatment. VAD can be occluded, and this challenging endovascular treatment can be a therapeutic option for a ruptured VAD.