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Neurological Surgery No Shinkei Geka Volume 44, Issue 1 （January 2016）

Neurological Surgery 脳神経外科 44巻1号（2016年1月発行）

Japanese English

症例

全身血管病に起因する頚部内頚動脈解離性動脈瘤に対してstent-assisted coil embolizationが有効であった1例 Efficacy of Stent-Assisted Coil Embolization for a Dissecting Aneurysm of the Cervical Internal Carotid Artery Caused by a Systemic Vascular Disease:A Case Report 高宮宗一朗 ¹ , 長内俊也 ² , 牛越聡 ² , 栗栖宏多 ¹ , 下田祐介 ¹ , 伊藤康裕 ¹ , 伊師雪友 ¹ , 穂刈正昭 ¹ , 中山若樹 ¹ , 数又研 ¹ , 鐙谷武雄 ¹ , 七戸秀夫 ¹ , 寳金清博 ¹ Soichiro TAKAMIYA ¹ , Toshiya OSANAI ² , Satoshi USHIKOSHI ² , Kota KURISU ¹ , Yusuke SHIMODA ¹ , Yasuhiro ITO ¹ , Yukitomo ISHI ¹ , Masaaki HOKARI ¹ , Naoki NAKAYAMA ¹ , Ken KAZUMATA ¹ , Takeo ABUMIYA ¹ , Hideo SHICHINOHE ¹ , Kiyohiro HOUKIN ¹ ¹北海道大学大学院医学研究科脳神経外科学講座 ²北海道医療センター脳神経外科 ¹Department of Neurosurgery, Hokkaido University Graduate School of Medicine ²Department of Neurosurgery, National Hospital Organization Hokkaido Medical Center キーワード： Behçet's disease , stent-assisted coil embolization , internal carotid artery dissecting aneurysms Keyword: Behçet's disease , stent-assisted coil embolization , internal carotid artery dissecting aneurysms pp.39-45

発行日 2016年1月10日 Published Date 2016/1/10

DOI https://doi.org/10.11477/mf.1436203205

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Ⅰ．はじめに

　特発性頚部内頚動脈解離性動脈瘤の原因として，線維筋性異形成，Ehlers-Danlos症候群，Marfan症候群，Behçet病などの全身血管病の関与が知られている．これらの疾患は，血管脆弱性が背景にあることが多いため，解離性病変に対しては侵襲的な治療よりも，原疾患に対する保存的な治療が選択されることが多い．しかし，病変の形状や大きさが進行性に変化する場合や出血リスクが高いと判断される場合には，手術治療や血管内治療などの侵襲的治療も選択肢となり得る．ただし，どちらの治療法がよりよいかというコンセンサスは未だ得られていない．

　今回われわれは，頚部内頚動脈解離性動脈瘤を生じた血管Behçet病疑診の症例に対してstent-assisted coil embolizationを施行したので，文献的考察を交えて，その有効性を報告する．

　Systemic vascular diseases such as fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan syndrome, and Behçet's disease are known to cause spontaneous dissecting aneurysms of the cervical internal carotid artery. These diseases are generally associated with vascular fragility；therefore, invasive treatments are avoided in many cases of dissecting aneurysms, and a conservative approach is used for the primary disease. Surgical or intravascular treatment may be chosen when aneurysms are progressive or are associated with a high risk of hemorrhage；however, there is no consensus on which treatment is better.

　We report a case of a dissecting aneurysm of the cervical internal carotid artery in a patient with suspected Behçet's disease, which was treated using stent-assisted coil embolization.

　A man in his 40’s, with suspected Behçet's disease, presented with an enlarged dissecting aneurysm of the right cervical internal carotid artery. The lesion was present for approximately 10 years. We performed stent-assisted coil embolization for the lesion. Post-surgery, no aneurysms were detected with carotid artery echography.

　Our case report suggests that stent-assisted coil embolization is a promising treatment for dissecting aneurysms of the cervical internal carotid artery. In addition, the procedure demonstrates the utility of carotid artery echograms for examining recanalization after stent-assisted coil embolization.