血管内塞栓療法で治療した特発性血小板減少性紫斑病を合併した破裂中大脳動脈瘤の1例

Ruptured Middle Cerebral Artery Aneurysm Successfully Treated by Intra-aneurysmal GDC Embolization in a Patient with Idiopathic Thrombocytopenic Purpura : a case report

I．はじめに

　1991年，Guglielmi detachable coil（GDC）が発表されて以来，瘤内塞栓療法が破裂動脈瘤に対する治療の選択肢の一つと考えられるようになった．現在のところ，開頭術に特に問題のない症例は外科的に治療することが原則になっているが，高齢やpoor gradeの理由で血管内治療を施行する症例も増加している^3,4）．今回われわれは急性期に十分な血小板輸血の確保が困難だったために血管内治療を選択し，良好な予後を得た症例を経験したので報告する．

We report a case of a ruptured middle cerebral artery (MCA) aneurysm treated by an intra-aneurysmalGuglielmi detachable coil (GDC) embolization in a patient with idiopathic thrombocytopenic purpura (ITP). A 57-year-old female, who had been suffering from ITP for 4 years, experienced sudden severeheadache. She was diagnosed as having subarachnoid hemorrhage due to a ruptured MCA aneurysm andthe hematological examination showed moderate thrombocytopenia. Considering the risk of open surgery,we treated the aneurysm by intra-aneurysmal GDC embolization in the acute stage and platelet transfusionwas carried out after the therapy. She had a good clinical course and recovered without any complicationsor neurological symptoms. The follow-up cerebral angiogram at 1 week and 2 years after the treatmentshowed complete obliteration of the aneurysm.

Recently, endovascular treatment tends to be applied to surgically high-risk patients. A GDC emboliza-tion for a patient with thrombocytopenia has rarely been reported and the risk and efficacy is unknown.So, we conclude that for a patient with thrombocytopenia, intra-aneurysmal GDC embolization could beadopted as one of the less invasive treatment for ruptured aneurysm.