中大脳動脈再開通後に認めた脳動脈瘤の2例

Two Cases of Cerebral Aneurysm Detected after Recanalization of the Middle Cerebral Artery

I．はじめに

　カテーテルと血管撮影機器の発達や手技の上達にともない，急性期脳主幹動脈閉塞に対する血栓溶解療法や血管拡張術は益々広がりつつある．今回われわれは中大脳動脈再開通後に，開通前には見られなかった動脈瘤を認めた2例を経験した．急性期動脈閉塞に対して血管内手術を施行するにあたり，注意を喚起する症例と思われたので報告する．

Two cases of aneurysm incidentally detected after recanalization of middle cerebral artery (MCA) occlu-sion are reported. Patient 1 was a 62-year-old male with sudden onset of left hemiparesis. We performedemergent intravascular surgery. The initial cerebral angiography revealed occlusion at the MI portion ofthe right MCA. After partial recanalization with a microcatheter, carotid angiography revealed a right MI-M2 junction aneurysm. Due to the risk of aneurysmal rupture, the thrombolytic procedure was stopped.Follow up angiography after 1 month revealed complete recanalization of the right MCA and a persistentaneurysm. Patient 2 was a 65-year-old male with left hemiparesis. The initial cerebral angiography re-vealed occlusion at the M1 portion of the right MCA. After 1 month follow-up cerebral angiography re-vealed spontaneous recanalization of the right MCA and an incidental aneurysm at the MI-M2 junction.Neck clipping of the aneurysm was performed. When using a microcatheter or microballoon catheter totreat arterial occlusion, surgeons should consider the possibility of a rupture of a hidden aneurysm.