Radiation-induced arterial injuryによる両側内頸動脈狭窄に対しステント留置術を行った1症例

Bilateral Carotid Stenting for Radiation-Induced Arterial Stenosis

I．はじめに

　放射線障害による内頸動脈（ICA）狭窄症に対する治療として従来から頸動脈内膜剥離術（CEA）が行われているが，血管周囲組織のfibrosisにより剥離に難渋するなど，手技的困難な状況が存在することが報告されている^1,5,9,11）．近年血管内治療の発達により経皮的血管形成術（PTA）やステント留置術が比較的安全に行われるようになり，CEA困難症例には代わり得る治療法として試みられている^3,16）．今回われわれは，放射線障害による両側ICA狭窄症に対しステント留置術を行い良好な結果が得られたので，文献的考察を含め報告する．

We report a case of bilateral radiation-induced internal carotid artery (ICA) stenosis treated with stent-ing. A 67-year-old man experienced transient left hemiparesis several times, and it was diagnosed as a bi-lateral ICA stenosis by magnetic resonance angiogram (MRA) and cervical ultrasound sonogram (US).Ten years before, the patient had received radiation therapy (66 Gy) and radical resection for a squamouscell carcinoma (SCC) in the right infrapharyngeal space. A cerebral angiogram showed bilateral severeICA stenosis (right; 90%, left; 99%). We diagnosed this as radiation-induced ICA stenosis, and performedcarotid angioplasty with a self-expanding stent. The post-operative course was uneventful and the patientwas discharged without neurological deficits. Carotid endarterectomy (CEA) is difficult in the case of caro-tid artery stenosis due to radiation-induced arterial injury. Carotid stenting may be an alternative treatmentfor such a patient.