鎖骨下動脈，椎骨動脈起始部狭窄症に対するPercutaneous Translumimal Angioplasty（PTA）—治療適応と安全に行うための工夫

Percutaneous Transluminal Angioplasty (PTA) for Stenosis at the Subclavian Artery and at the Origin of the Vertebral Artery:Therapeutic indication and some adjunctive safe methods during PTA

I．はじめに

　近年interventional radiologyの進歩により冠状動脈，腎動脈，四肢末梢動脈のみならず頭頸部主幹動脈の狭窄性病変に対してもpercutaneous translurninal angio—plasty（PTA）が広く応用されている^{2,4,6,7,12,13,17,19）}．われわれは24例の鎖骨下動脈狭窄症，椎骨動脈起始部狭窄症に対してPTAを試み，同疾患の治療適応，治療方針等に若干の知見を得たので報告する．また手技を安全に行うために一部の症例でPTA前に血管内視鏡にて狭窄部内腔を観察した．さらにPTA施行中に狭窄近位部または遠位部にprotective balloonを留置し，distal embolismの予防を行ったのでそれらの方法も合わせて報告する．

Percutaneous transluminal angioplasty (PTA) for brachiocephalic occlusive lesions has progressed. In this paper our experiences and results of PTA in dealing with those lesions are described with emphasis on ad-junctive procedures during PTA. Recently, twenty-four patients with stenosis of the subclavian artery (SA) and/or stenosis at the origin of the vertebral artery (VA) were included in this study. Among the 24, there were 16 cases with SA stenosis, 6 cases with ste-nosis at the origin of VA and 3 cases with both SA and stenosis at the origin of VA. The stenosis was due to atherosclerosis in 21 cases and aortitis in 3 cases.