頚動脈浮遊血栓に対し頚動脈エコーガイド下に血管内治療を行った1例

A Case of Carotid Free-Floating Thrombus Treated by Carotid Ultrasonography-Guided Endovascular Approach

Ⅰ．はじめに

　頚動脈エコーにて観察される可動性のプラークや血栓は脳塞栓症の高危険因子とされ，緊急手術も考慮され得る病態である^2,3,6)．今回われわれは脳塞栓症の精査にて発見された頚動脈浮遊血栓（carotid free-floating thrombus：carotid FFT）に対して，頚動脈エコーガイド下に血管内治療を行い良好な結果を得た1例を経験したので報告する．

　We experienced a case of carotid free-floating thrombus treated by carotid ultrasonography-guided endovascular approach. A 63-year-old man was brought to our hospital with the chief complaint of sudden onset left hemiplegia. MRI revealed acute infarction of the right MCA territory due to the right M1 occlusion. Carotid ultrasonography showed a pedunculated, polypoid mobile plaque floating with the cardiac beat. We attempted ultrasonography-guided endovascular treatment. Under proximal balloon protection, the floating plaque was successfully aspirated into the Penumbra aspiration catheter. Carotid stent was also placed to stabilize the residual pedicle of the plaque. Aspirated plaque was identified as fresh thrombus by pathological examination. Carotid ultrasonography-guided endovascular approach was effective for getting the picture of real-time dynamics of the carotid FFT.