頚部内頚動脈狭窄症を有する進行胃癌患者に対し緊急頚動脈ステント留置術を行った1例

A Patient with Advanced Gastric Cancer who Underwent Emergency Stenting for Carotid Artery Stenosis

Ⅰ．はじめに

　担癌患者において，血液凝固障害が生じることで脳梗塞を発症することはよく知られている^1-3,6,7,14)．担癌患者に無症候性頚動脈狭窄病変が発見された場合，脳梗塞を発症する危険性がさらに高くなる可能性もあるが報告が少なく，一定の見解は得られていない．

　今回われわれは，頚部内頚動脈狭窄症を有する進行胃癌患者において，意識障害を伴う運動麻痺症状が出現したため緊急頚動脈ステント留置術（carotid artery stenting：CAS）を行い，良好な経過が得られた症例を経験した．担癌患者において頚部内頚動脈狭窄症が発見された場合の患者の管理について示唆に富む症例と考えたので，文献的考察を加え報告する．

　We report the case of a patient with advanced gastric cancer who underwent emergency stenting for carotid artery stenosis that was causing fluctuating symptoms of cerebral ischemic stroke. A 66-year-old man presented with transient dysarthria and right hemifacial palsy. Examination revealed left internal carotid artery stenosis, as well as anemia caused by advanced gastric cancer. The man was treated on an outpatient basis using antiplatelet medication and anti-cancer therapy. Two months later, he developed recurrent ischemic stroke;because of this progression, a stent was placed in the carotid artery. After surgery, the cerebral ischemia resolved and did not recur before his death 6 months later. In conclusion, surgical intervention is a viable treatment option for internal carotid artery stenosis in cancer patients whose general health status is good.