鎖骨下動脈高度狭窄病変に対してエキシマレーザー(eximer laser）併用血管形成術を施行した1例

Excimer Laser Angioplasty for Subclavian Artery Stenosis－Case Report

はじめに

　鎖骨下動脈狭窄症に対する血管内治療（ステント留置術）は，低侵襲かつ有効な治療法である。しかし，高度狭窄病変の中にはガイドワイヤーやバルーンの不通過が原因で拡張が得られない症例が存在する。冠動脈や末梢血管において，レーザーカテーテルはデバルキングデバイスとして用いられており，その有用性が期待されている。今回われわれは，ガイドワイヤー通過後，バルーン通過困難であった左鎖骨下動脈高度狭窄病変に対し，エキシマレーザー併用血管形成術を施行し，良好な結果を得た1例を経験したので報告する。

Abstract

　Endovascular angioplasty for subclavian artery stenosis is effective and less invasive than other methods; however, it is difficult to advance guidewires or balloon catheters through severely stenotic lesions.　We report a case of subclavian artery stenosis treated with excimer laser angioplasty.

　A 58-year-old man with hypertension and hyperlipidemia was admitted to a hospital with different blood pressure in each arm.　A CT scan revealed left subclavian artery stenosis, and the patient was transferred to our hospital.　An angiogram revealed a severely stenotic lesion in his left subclavian artery, representing subclavian steal phenomenon.　Endovascular angioplasty was performed under local anesthesia with embolic protection for the left vertebral artery.　The guidewire successfully crossed the lesion, and stepwise balloon angioplasty was performed using increasing balloon sizes from 1.5 to 2.0 mm; however, the next size balloon catheter could not cross the lesion, and we therefore decided to use an excimer laser catheter.　After laser ablation, revascularization was performed via stent placement.　The patient's symptoms and subclavian steal phenomenon improved, and the post-operative course was uneventful.　Excimer laser angioplasty appears to be effective in the treatment of occlusive lesions that cannot be crossed using a balloon catheter.

(Received: March 3, 2008, Accepted: June 16, 2008)