動脈瘤の塞栓術でgoose neck snareによる親カテーテルの保持が有用であった1例

A case of cerebral aneurysm using a goose neck snare to stabilize the guiding catheter during embolization

I．はじめに

　狭窄性病変に対する経皮的血管拡張術（PTA）や脳動脈瘤に対する塞栓術等，血管内手術の適応はますます広がりつつある．血管内手術の際に，動脈硬化の強い症例ではguiding catheter（親カテーテル）が目的の位置にうまく留置できずに，マイクロカテーテルを遠位部に誘導できないといったことはよく経験される．今回われわれは脳動脈瘤塞栓術において親カテーテルの固定にグースネックスネアが有効であった1例を経験したので報告する．

Severe arteriosclerotic changes often prevent navigat-ing a guiding catheter into an appropriate position dur-ing aneurysm embolization. A basilar superior cerebel-lar artery aneurysm was found in a patient who had had subarachnoid hemorrhage 6 months previously.

We selected embolization for this aneurysm using Guglielmi detachable coils (GDC) because of its highly located position from the dorsum sellae. We could not introduce a guiding catheter into the distal portion of the vertebral artery because of severe arteriosclerotic changes and it easily prolapsed into the aorta when a microcatheter was navigated through the guiding cathe-ter positioned in the proximal vertebral artery. We were able to successfully perform embolization of the aneu-rysm by fixing a guiding catheter at the origin of the left vertebral artery with a goose neck snare wire intro-duced from the left brachial artery. The authors empha-size that a snare wire is useful not only for retrieval of foreign bodies but also for fixing a guiding catheter during aneurysm embolization, especially in which pro-lapse of the guiding catheter may cause a serious com-plication.