椎骨動脈狭窄によるprogressing strokeに対してバルーン血管形成術が有効であった1例

A Case of Vertebral Artery Stenosis Presenting with Progressing Stroke and Treated by Percutaneous Transluminal Angioplasty

Ⅰ．はじめに

　急性期脳梗塞に対する血管内治療はデバイスの改良もあり，急速に発展してきている．頭蓋内主幹動脈の動脈硬化性の病変に対してはバルーン血管形成術（percutaneous transluminal angioplasty：PTA）やステント留置術が行われるようになったが，その適応などを含めて課題も多い．今回われわれは，progressing strokeを呈した椎骨動脈狭窄に対してPTAを施行した．症例を報告し，ステント留置術の適応などについて考察する．

　A 75-year-old man with a history of diabetes mellitus and hypertension was suffered from dizziness and vomiting and brought to the near-by hospital. MRI showed cerebellar infarction due to right vertebral artery stenosis. Despite best medical treatment, the infarction progressed day by day and he was transferred to our hospital five days later. Neurological examination showed mild disturbance of consciousness and right hemiparesis. Right vertebral angiography revealed high-grade stenosis accompanied with atherosclerosis at the V3-V4 portion. Percutaneous transluminal angioplasty（PTA）was performed with 2.5mm×14mm balloon with 6 atm dilation. Postoperative course was uneventful and no further stroke occurred after the treatment. PTA was effective for vertebral artery stenosis manifested with progressing stroke. The indication of stent placement for the cerebral artery should be prudent.