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Neurological Surgery No Shinkei Geka Volume 24, Issue 12 （December 1996）

Neurological Surgery 脳神経外科 24巻12号（1996年12月発行）

Japanese English

症例

Rescue PTAおよびdeferred PTAによる段階的血管拡張が奏効した急性期頸部内頸動脈閉塞症の1例 A case of acute occlusion of the cervical portion of the right internal carotid artery with successful stepwise vascular dilatation by rescue PTA and deferred PTA 須賀俊博 ¹ , 渡辺徹雄 ² , 渡辺美喜雄 ³ , 大和田雅信 ³ , 千葉明善 ³ , 吉岡邦浩 ⁴ , 細矢貴亮 ⁵ Toshihiro SUGA ¹ , Tetsuo WATANABE ² , Mikio WATANABE ³ , Masanobu OOWADA ³ , Meizenn CHIBA ³ , Kunihiro YOSHIOKA ⁴ , Takaaki HOSOYA ⁵ ¹釜石市民病院脳神経外科 ²東北大学第二外科 ³岩手県立釜石病院脳神経外科 ⁴せいてつ記念病院放射線科 ⁵山形大学放射線科 ¹Department of Neurosurgery, Kamaishi Municipal Hospital ²Second Department of Surgery, Tohoku University School of Medicine ³Department of Neurosurgery, Iwate Prefectural Kamaishi Hospital ⁴Department of Radiology, Seitetu Memorial Hospital ⁵Department of Radiology, Yamagata University School of Medicine キーワード： rescue PTA , deferred PTA , internal carotid occlusion , stepwise vascular dilatation Keyword: rescue PTA , deferred PTA , internal carotid occlusion , stepwise vascular dilatation pp.1101-1106

発行日 1996年12月10日 Published Date 1996/12/10

DOI https://doi.org/10.11477/mf.1436901315

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Abstract 文献概要
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I．はじめに

　脳梗塞急性期での経皮的血管形成術（percutaneous transluminal angioplasty：PTAと略す）の有用性を示す報告が散見されるようになってきた^9,14-16）．PTAには，血栓溶解療法成功後，残存狭窄に対するimmediate PTA，血栓溶解療法のみで再開通が得られない場合に迅速に再開通をはかるため行うrescue PTA，発症18時間から1週間の間に施行されるdeferred PTA，血栓溶解療法を併用しないdirect PTAなどがある^2,4,15）．

　これまで頸部内頸動脈狭窄症に対するPTAの有用性の報告は多い^{5,6,11,12,16）}．これに対し，頸部内頸動脈閉塞症急性期においては，経皮的血栓溶解術や経皮的血管形成術が著効した報告がみられるものの^9,14,15），再開通に伴う致死的出血性梗塞や頭蓋内血管への塞栓などの合併症の頻度が高く，むしろ禁忌とする報告もある^3）．特にgolden hourとされる6時間を越えれば，合併症の危険は非常に高くなる．

A case is reported of acute occlusion of the cervical portion of the internal carotid artery, which was re-canalized and dilated by steps through rescue percu-taneous transluminal angioplasty (PTA) and deferred PTA.

A 53-year-old man, complaining of progressive dis-turbance of consciousness and hemiplegia, was admit-ted to our department at about 7 hours after onset. CT demonstrated no abnormality. Digital subtraction angiography revealed an occlusion of the right cervical internal carotid artery. After intra-arterial injection of t-PA, a guide wire was able to be passed through the artery. Recanalization of internal carotid artery was performed by rescue PTA with Stealth FS angioplastic balloons of small diameter. Residual stenosis ratio was about 80%. After rescue PTA, his symptoms improved. On the following day, deferred PTA with Stealth FS angioplastic balloons of larger diameter was performed. Stenosis ratio was 30%. After the procedure, his palsy was relieved. DSA in the 3rd week after the PTA re-vealed that the stenosis ratio had changed from 30% to 13%.

Rescue PTA is very effective for prompt recanaliza-tion. Stepwise vascular dilatation by rescue PTA with small balloons followed by deferred PTA can improve symptoms and prevent fatal hemorrhagic infarction. This method is especially useful for high risk patients of cervical internal carotid artery occlusion.