橈骨動脈グラフトが奏効した医原性内頸動脈解離の1例

A Case of Iatrogenic Carotid Artery Dissection Treated with Radial Artery Graft

I．はじめに

　内頸動脈解離の中で，外傷に起因しない特発性内頸動脈解離は比較的自然治癒する頻度が高く，保存的治療を第一選択とすることが多い^12）．これと比較して外傷性の頸動脈解離に関しては血行再建術などの外科的処置を必要とすることが少なくなく^12,15），近年，血管内手術によるステント留置にて治療を行った報告^{3,11,12,15）}も散見されるようになってきている．今回われわれは，くも膜下出血の症例に対する脳血管撮影で内頸動脈解離を来したと考えられる症例を経験した．外傷性内頸動脈解離の治療方針について検討を加えたのでここに報告する．

A case of iatrogenic intracranial artery dissection is reported. A 52-year-old female developed severe headache and nausea. Brain CT showed diffuse subarachnoid hemorrhage. On admission, carotid angiogra-phy revealed an aneurysm in the right middle cerebral artery and the intact right internal carotid artery. The aneurysm was clipped successfully. Carotid angiography on clay 7 revealed dissection in the right in-ternal carotid artery. Repeated angiograms at 10 and 31 clays showed progression of the carotid artery dis-section. Findings of ECD-SPECT on clay 31 (Balloon occlusion test) suggested low perfusion of the right internal carotid artery territory.

The patient underwent surgical reconstruction of the right internal carotid artery using a radial artery. She presented with right abducens nerve palsy three clays after the radial artery graft. The patency of the radial artery graft was proved by the post-operative angiography. Internal carotid artery dissection may occur spontaneously or as a result of trauma. An iatrogenic dissection is an uncommon complication of cerebral angiography. There are no evidence-based guidelines for the treatment although anticoagulation therapy is most commonly used. The present case emphasizes the usefulness of radial artery graft for traumatic carotid artery dissection.