遠位部塞栓を繰り返した頸部椎骨動脈解離の1例

Extracranial Vertebral Artery Dissection Repeating Distal Embolism ： Case Report

Ⅰ．はじめに

　椎骨動脈解離（vertebral artery dissection; VAD）は，患側椎骨動脈を閉塞する治療法をとることが多く，頸部痛，虚血症状などで発症した例については，治療の適応，タイミングはcontroversyである．今回遠位部塞栓を繰り返したVADを経験したので，治療の適応とタイミングについて検討する．

We report a case of vertebral artery (VA) dissection presenting with repeated distal embolism. A 48-year-old man was admitted to our institution with neck pain and vertigo of two day duration. MRI on arrival showed infarction of the left cerebellar hemisphere and the right occipital lobe. Emergency angiography revealed left VA dissection and occlusion of the left posterior inferior cerebellar artery and right calcaline artery. Six hours after admission,he manifested cortical blindness due to emboism of the contralateral left calcaline artery despite giving heparin and aspirin. Thrombolysis was performed but was not successful. We embolized the affected VA to prevent further embolism.

　We discuss here the indication and timing of treatment for VA dissection presenting with ischemic symptom.