興味ある頭蓋外側副血行路を認めた内頸動脈狭窄・外頸動脈閉塞症の1例

Internal Carotid Artery Stenosis and External Carotid Artery Occlusion with Unusual Extracranial Collateral Pathway:Case report

I．はじめに

　通常頭蓋外内頸動脈からの分枝は認められず，稀に上行咽頭動脈・後頭動脈・primitive hypoglossal artery・primitive proatlantal arteryなどが分枝すると報告されている^4,7）．著者らは上行咽頭動脈が頭蓋外内頸動脈から分枝し，興味ある頭蓋外側副血行路を認めた内頸動脈狭窄・外頸動脈閉塞を呈した症例を経験したので文献的考察をくわえて報告する．

Abstract

A patient with stenosis of the internal carotid artery and occlusion of the external carotid artery associated with an unusual extracranial collateral pathway is pre-sented.

A 63-year-old man was hospitalized for sudden onset of black-out after urination. He was alert, and no neuro-logical deficit was found. MRI showed multiple lacunae in the bilateral putamens. Cerebral angiogram demon-strated severe stenosis of the left internal carotid artery at its cervical segment and complete occlusion of the left external carotid artery at its origin. The ascending pharyngeal artery originated from the left internal caro-tid artery above its stenotic lesion and the superior thyroid artery originated from the left common carotid artery. The sternocleidomastoid branch from the left superior thyroid artery and the muscular branch from the left vertebral artery anastomosed with the muscular branch of the ascending pharyngeal artery. The ascend-ing pharyngeal artery maintained patency of the inter-nal carotid artery.

It is important to perform vertebral angiography when there is proximal occlusion and severe stenosis of the internal carotid artery, and when the ascending pharyngeal artery has not been clearly identified as a branch from the ipsilateral external carotid artery on the common carotid angiogram.