ステント留置が奏功した特発性頸部内頸動脈解離の1例

A Case of Spontaneous Cervical Carotid Artery Dissection Managed by Using Primary Stent Placement

I．はじめに

　特発性頸部内頸動脈解離は，従来稀な疾患と考えられてきたが^1,14），疾患への認識と画像診断の発達に伴いその報告例は増加しつつある^{15,16,21,25）}．最近では，特に若年者の虚血性脳疾患の原因として重要と考えられている^10,23）．しかし，その治療にステント留置術を応用した報告例は少ない^3,5,17）．今回，著者らは特発性頸部内頸動脈解離に対しステント留置術を行い，良好な結果を得た1例を経験したので，文献的考察を加えて報告する．

The authors report the case of a 35-year-old male who underwent stenting for spontaneous cervical caro-tid dissection. He presented with sudden onset of hemicrania and left facial palsy followed by left hemipa-resis and dysarthria. On admission, carotid angiography revealed postsinus tapering occlusion of the right internal carotid artery. Initially, he was managed with conservative treatment, but his neurological status deteriorated. Findings of brain CT, MRI and IMP-SPECT suggested hypoperfusion of the right cerebrum.A Palmaz stent, 39mm in length, was successfully placed over the site of the dissection to restore normal patency through the dissected carotid artery. Following stent implantation, his neurological signs improved gradually but completely. Since the procedure, with oral administration of antiplatelet medication, he has suffered no cerebral ischemic events. Follow-up carotid angiography one year after stent implantation showed good patency of the stented segment. The present case emphasizes the usefulness of stenting for spontaneous cervical carotid dissection.