椎骨脳底動脈血行不全症に内頸動脈狭窄を合併した症例に対して急性期頸動脈内膜剥離術を施行した1例

A Case of Emergency Carotid Endarterectomy to Cope with Vertebrobasilar Insufficiency

I．はじめに

　頸部頸動脈閉塞性病変に対する頸動脈内膜剥離術（carotid endarterectomy，以下CEA）は内頸動脈領域の血流改善を目的として行われている．今回われわれは後交通動脈を介して血流が保持されていた椎骨脳底動脈血行不全症の症状増悪例に対して，合併していた頸部頸動脈の高度狭窄に急性期のCEAを施行し興味ある経過を経験したので報告する．

This is a report of an emergency carotid endar-terectomy preformed on a 59 year-old male. He had been suffering from TIA of vertebrobasilar insufficien-cy since 1 day prior to admission. Angiography re-vealed severe stenosis and ulceration of the left cervical carotid bifurcation and occlusion of the bilateral verte-bral arteries. Six hours after angiography, he showed hemiparesis, decerebrated posture and consciousness disturbance. These neurological signs were considered to be derived from occlusion of the left carotid bifurca-tion and disappearance of the collateral circulation via the left posterior communicating artery.

Emergency carotid endarterectomy was performed to prevent brain infarction of the anterior and posterior circulation. Postoperative angiography showed dis-appearance of the stenosis of the carotid bifurcation and the recanalization of the left vertebral artery, and of the atherosclerotic stenosis of the left intracranial vertebral artery. It was considered that the left verte-bral artery had been occluded by growth of a local thrombosis at the left intracranial vertebral artery.