内頸動脈狭窄症例に対する急性期Percutaneous Transluminal Angioplasty（PTA）の1例

Percutaneous Transluminal Angioplasty for Cervical Internal Carotid Artery Stenosis: Case report

I．はじめに

　PTA（percutaneous transluminal angioplasty）は，1964年にDotterら^4）により始められた方法で，1974年にGruntzigら^5）がポリ塩化ビニル製のballoon catheterを開発し，以後脳神経外科疾患にも応用されるようになってきた．現在，脳神経外科領域のPTAは主に鎖骨下動脈領域以外に椎骨動脈，頸動脈の動脈硬化性狭窄の慢性期や高安病，fibromuscular dysplasiaの狭窄病変に対して行われるようになった．また最近はクモ膜下出血後のvasospasmに対しても試みられるようになってきている．今回われわれは，急性期内頸動脈狭窄症例に対してPTA治療を行い，良好な結果を得ることができたので文献的考察を加えて報告する．

We encountered one case of right cervical internal carotid artery (ICA) stenosis with ulcerative plaque. The patient was treated using percutaneous translumin-al angioplasty (PTA). A 70 year-old man complained of left motor weakness and left hemidysesthesia. CT scan on the day of admission showed no abnormal findings. Angiographical findings revealed a severe right ICA stenosis with ulcerative plaque. We first treated the pa-tient conservatively because of high-positioned carotid bifurcation, bronchial asthma and hypertension. 20 hours after the stroke, left motor weakness gradually worsened and CT scan revealed multiple low-density areas in the right fronto-parieto-occipital watershed re-gion. Because of this, we treated the stenosed ICA by PTCA balloon dilatation catheter, and successfully obtained adequate dilatation with no complications. We propose that PTA of ICA stenosis, as well as PTA of the vertebral region, is a useful method for patients who have conditions which would make surgical opera-tions risky.