塞栓術後遅発性にコイル突出を来した破裂脳動脈瘤の2例

Two Cases of Ruptured Cerebral Aneurysm Complicated with Delayed Coil Protrusion after Coil Embolization

Ⅰ．はじめに

　破裂脳動脈瘤の治療において，塞栓術は直達手術に比べて機能予後良好であることがInternational Subarachnoid Aneurysm Trial（ISAT）やBarrow Ruptured Aneurysm Trial（BRAT）にて示され^7,9)，塞栓術が選択される症例が増加している．塞栓術の合併症として，動脈瘤穿孔や血栓塞栓症，血管損傷，コイルの母血管への突出などがある．瘤内塞栓術中に離脱したコイルが母血管へ突出してしまうことはしばしば経験される合併症であるが^5,8,15)，術後遅発性に母血管へのコイル突出を来した症例の報告は少ない．今回われわれは，破裂脳動脈瘤の塞栓術後，遅発性に瘤内より母血管へコイルが突出してきた2症例を経験した．術後のコイル突出の機序，対処法について文献的考察を加えて報告する．

　We report two cases of delayed coil protrusion after coil embolization for ruptured cerebral aneurysms. Case 1:An 82-year-old woman with a subarachnoid hemorrhage due to a ruptured small anterior communicating artery aneurysm underwent successful coil embolization. Eighteen days after the procedure, coil protrusion from the aneurysm into the right anterior cerebral artery was observed without any symptoms. Further coil protrusion did not develop after 28 days. Case 2:A 78-year-old woman with a subarachnoid hemorrhage due to a ruptured small left middle cerebral artery aneurysm underwent successful coil embolization. Twenty days after the procedure, coil protrusion from the aneurysm into the left middle cerebral artery was observed, with a transient ischemic attack. Further coil protrusion did not develop. Both patients recovered with antithrombotic treatment. Even though delayed coil protrusion after coil embolization is rare, it should be recognized as a long-term complication of coil embolization for cerebral aneurysms.