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Neurological Surgery No Shinkei Geka Volume 28, Issue 11 （November 2000）

Neurological Surgery 脳神経外科 28巻11号（2000年11月発行）

Japanese English

症例

急性大動脈解離の波及による総頸動脈解離に対してPTAを施行した1例 Common Carotid Artery Dissection Propagated from Acute Aortic Dissection : A Case Successfully Treated by PTA 久保田司 ^1,2 , 丹羽潤 ¹ , 千葉昌彦 ¹ , 三上毅 ¹ , 岡真一 ¹ Tsukasa KUBOTA ^1,2 , Jun NIWA ¹ , Masahiko CHIBA ¹ , Takeshi MIKAMI ¹ , Shinichi OKA ¹ ¹市立函館病院脳神経外科 ²北海道社会事業協会帯広病院脳神経外科 ¹Department of Neurosurgery, Hakodate Municipal Hospital ²Department of Neurosurgery, Hokkaido Social Work Association Obihiro Hospital キーワード： acute aortic dissection , common carotid artery dissection , PTA Keyword: acute aortic dissection , common carotid artery dissection , PTA pp.1015-1021

発行日 2000年11月10日 Published Date 2000/11/10

DOI https://doi.org/10.11477/mf.1436901973

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Abstract 文献概要
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I．はじめに

　急性大動脈解離（以下AADと略する）は急性期予後がきわめて不良な重篤な疾患^6,9）である．AADは上行大動脈の解離の有無によりStanford type Aとtype Bに分類される^7）が，type Aは大動脈弓分枝への解離の波及により脳血管の解離を合併することがある^2,3,10-12）．今回，AAD type Aの右頸動脈への波及による脳虚血症状で発症した症例に対して，経皮的血管形成術（以下PTAと略する）を施行し良好な結果を得たので報告する．

We reported a rare case, which was successfully treated by PTA, of right common carotid artery dissec-tion propagated from acute aortic dissection (AAD) type A.

A 45-year-old male with a past history of hypertension and an artificial graft replacement of the abdomi-nal aorta due to AAD type B, 7 years ago, was brought into our hospital by ambulance 30 minutes after an attack of fainting and left hemiparesis. On admission, the patient complained not.of chest pain or left hemi-paresis, but nausea. At that time his consciousness level was JCS 1. During examinations, he had the same attack twice and his consciousness level deteriorated to JCS 2. Brain MRI showed no abnormality, but cer-vical MRA did not visualize the right carotid artery and thoracic CT depicted acute aortic dissection in-cluding branches of the aorta. Emergent angiography disclosed that the dissecting 99% stenosis of the right common carotid artery had developed from AAD type A with poor collateral blood flow. PTA was carried out 8 times and reduced the residual stenosis to about 50% with shortened circulation time. The patient's consciousness disturbance improved. After the replacement of the whole aortic arch in an artificial graft, the residual stenosis disappeared. The patient recovered without neurological deficit but right frontal silent embolic infarction caused by the artificial graft replacement was detected.

AAD is a catastrophic illness and sometimes accompanied by devastating ischemic cerebral disease (ICD) because of propagation of dissecting to extracranial vessels. This is the first report that shows the efficacy of PTA for treatment of ICD associated with AAD.