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Neurological Surgery No Shinkei Geka Volume 48, Issue 1 （January 2020）

Neurological Surgery 脳神経外科 48巻1号（2020年1月発行）

Japanese English

症例

Non-bifurcating cervical carotid artery stenosisに対する頚動脈ステント留置術 Carotid Artery Stenting for Non-bifurcating Cervical Carotid Artery Stenosis:A Case Report 佐瀬泰玄 ¹ , 伊藤英道 ¹ , 内田将司 ¹ , 田中雄一郎 ¹ Taigen SASE ¹ , Hidemichi ITO ¹ , Masashi UCHIDA ¹ , Yuichiro TANAKA ¹ ¹聖マリアンナ医科大学脳神経外科 ¹Department of Neurosurgery, St. Marianna University School of Medicine キーワード： carotid artery stenting , double balloon occlusion , flow reversal , non-bifurcating cervical carotid artery stenosis Keyword: carotid artery stenting , double balloon occlusion , flow reversal , non-bifurcating cervical carotid artery stenosis pp.33-38

発行日 2020年1月10日 Published Date 2020/1/10

DOI https://doi.org/10.11477/mf.1436204130

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　Non-bifurcating cervical carotid artery（NBCCA）は総頚動脈が内頚・外頚動脈に分岐せず，複数の外頚動脈枝が直接分岐する頻度0.21%の稀な形態異常で¹¹⁾，その狭窄性病変に対する治療の報告は少ない^{2,5,7,9,10,12)}．今回われわれは，NBCCA狭窄に対してダブルバルーン閉塞下flow reversal法による塞栓予防策を講じて，安全にcarotid artery stenting（CAS）を施行できたので，技術上のポイントを考察を加え報告する．

　INTRODUCTION:Non-bifurcating cervical carotid artery（NBCCA）is a rare carotid artery anomaly, occurring at a rate of only 0.2%. We report a case in which carotid artery stenting（CAS）was performed for NBCCA stenosis.

　CASE REPORT:In a 69-year-old man had noted bilateral carotid artery stenosis was noted by chance during treatment for myocardial infarction. Carotid angiography revealed stenosis in both cervical carotid arteries, and the right side did not bifurcate（i.e. it was an NBCCA). Silent ischemia was observed in the left cerebral hemispheres in an MRI, and CAS was performed. A subsequent ultrasound examination revealed an increase in the peak systolic velocity in the right carotid artery, and CAS was planned for the right side. As it was not possible to use a guide-wire to guide into the external carotid artery, we planned to introduce it directly, approaching from the right brachial artery using a 6Fr Simmons guiding sheath. Angiography during distal balloon occlusion revealed significant retrograde flow from the facial and maxillary arteries to the internal carotid artery via the ophthalmic artery. Considering this finding, we decided to perform CAS with a femoral artery approach and flow reversal using distal and proximal balloon occlusion. Intraoperative embolism was prevented, and a successful treatment outcome was obtained.

　CONCLUSION:There are few reports of NBCCA stenosis treated with carotid endarterectomy or CAS. As CAS to treat NBCCA stenosis has several drawbacks, such as the impossibility of anchoring the wire in the external carotid artery. It is important to take appropriate steps to prevent distal embolism.