Trousseau症候群に伴い繰り返し生じた両側中大脳動脈閉塞症に対して血栓回収療法が有用であった1例

Successful Treatment of Repeated Bilateral Middle Cerebral Artery Occlusion by Performing Mechanical Thrombectomy in a Patient with Trousseau Syndrome

Ⅰ．緒　　言

　Trousseau症候群は悪性腫瘍に伴う血液凝固異常により脳卒中を生ずる病態であるが，頭蓋内の主幹動脈閉塞を来すことは稀といわれ，これに対して血栓回収療法を行った症例の報告は見あたらない．今回われわれは，悪性腫瘍の精査入院中に，初回は右側，次いで左側の中大脳動脈（middle cerebral artery：MCA）M1部の急性閉塞を短期間に相次ぎ発症し，いずれも脳血管内治療により再開通し得た症例を経験したので報告する．

　We report a patient with Trousseau syndrome who presented with repeated acute middle cerebral artery（MCA）occlusion, which was successfully treated by performing mechanical thrombectomy. A 66-year-old man with a lung lesion and abdominal lymph node swelling experienced a sudden onset of left hemiparesis. Magnetic resonance angiography（MRA）revealed a right MCA occlusion. Perfusion-weighted imaging revealed reduced cerebral blood flow in the right MCA territory. Complete recanalization of the occluded vessel was achieved by performing mechanical thrombectomy, and his symptoms remarkably disappeared. Twenty days after the procedure, he experienced right hemiparesis and total aphasia. MRA revealed a left MCA occlusion, which was located on the contralateral side of the first occlusion. The second mechanical thrombectomy was successfully performed, and complete recanalization was successfully achieved. Right hemiparesis improved after the procedure. Histological examination of the retrieved clots revealed coagulated fibrin and platelets. Cytodiagnosis of pleural effusion revealed adenocarcinoma, and he was diagnosed with lung adenocarcinoma and cancerous pleurisy. Trousseau syndrome was the presumed primary cause of the patient's tendency for thrombogenesis. To the best of our knowledge, there were no reports regarding the repeated use of mechanical thrombectomy for patients with bilateral MCA occlusion caused by Trousseau syndrome. Neuroendovascular therapy can offer good neurological outcomes even in patients with malignant lesions.