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Neurological Surgery No Shinkei Geka Volume 48, Issue 3 （March 2020）

Neurological Surgery 脳神経外科 48巻3号（2020年3月発行）

Japanese English

症例

異所性右鎖骨下動脈を有する破裂椎骨動脈瘤にコイル塞栓術を行った1例 Endovascular Treatment of a Ruptured Aneurysm of the Right Vertebral Artery with an Aberrant Right Subclavian Artery 近松元気 ^1,2 , 日宇健 ² , 大塚寛朗 ³ , 塩崎絵里 ^1,2 , 中村光流 ^1,2 , 川原一郎 ² , 森塚倫也 ² , 小野智憲 ² , 原口渉 ² , 牛島隆二郎 ² , 堤圭介 ² Genki CHIKAMATSU ^1,2 , Takeshi HIU ² , Hiroaki OTSUKA ³ , Eri SHIOZAKI ^1,2 , Hikaru NAKAMURA ^1,2 , Ichiro KAWAHARA ² , Tomoya MORITSUKA ² , Tomonori ONO ² , Wataru HARAGUCHI ² , Ryujiro USHIJIMA ² , Keisuke TSUTSUMI ² ¹国立病院機構長崎医療センター ²国立病院機構長崎医療センター脳神経外科 ³国立病院機構長崎医療センター神経内科 ¹National Hospital Organization Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center ³Department of Neurology, National Hospital Organization Nagasaki Medical Center キーワード： aberrant right subclavian artery , Kommerell's diverticulum , subarachnoid hemorrhage , vertebral artery ruptured aneurysm Keyword: aberrant right subclavian artery , Kommerell's diverticulum , subarachnoid hemorrhage , vertebral artery ruptured aneurysm pp.223-229

発行日 2020年3月10日 Published Date 2020/3/10

DOI https://doi.org/10.11477/mf.1436204166

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Ⅰ．はじめに

　異所性右鎖骨下動脈（aberrant right subclavian artery：ARSA）とは，右鎖骨下動脈が左鎖骨下動脈分岐部より遠位の下行大動脈から起始する，大動脈弓の形成異常である．発生頻度は約0.5〜2.0%と比較的稀であり，ARSAを有する患者に脳血管内治療を行った症例の報告は少ない．今回われわれは，ARSAを有する患者の脳動脈瘤コイル塞栓術を経験したので報告する．

　We report a rare case of the endovascular treatment of a ruptured aneurysm of the right vertebral artery with an aberrant right subclavian artery（ARSA).

　A 60-year-old woman was urgently admitted because of consciousness disturbance. Brain CT showed subarachnoid hemorrhage, and CT angiography showed a right vertebral ruptured aneurysm. Endovascular treatment of the aneurysm was performed via a transfemoral approach. During the endovascular treatment, the right subclavian artery was found to diverge from the descending aorta on the periphery of the left subclavian artery. An ARSA was detected, and the right vertebral artery（VA）originated from the ARSA. The guiding catheter was passed through the right VA via an ARSA, and the aneurysm was completely embolized. The patient was transferred to another hospital on day 44 without any motor weakness. To our knowledge, this is the first case of an ARSA with a ruptured aneurysm in the right VA for which endovascular treatment was successfully performed via the ARSA. In patients with an ARSA or aberrant left subclavian artery, the artery could merge with Kommerell's diverticulum（KD）at its origin and be histologically fragile. Thus, in patients with an ARSA, attention should be paid to catheterization to avoid injuring the KD. CT angiography of the aortic arch might be considered before endovascular treatment.