血管内手術が奏功したbow hunter's strokeの1例

A Case of Bow Hunter's Stroke Treated with Endovascular Surgery

Ⅰ．は じ め に

　頭部回旋によって椎骨動脈が頚椎C1-C2のレベルで狭窄し，椎骨脳底動脈領域の虚血症状を呈することがある．この疾患はbow hunter's strokeと言われ，いくつかの直達手術の有効性が報告されているが，今回血管内手術が有効であった例を経験したのでこれを報告する．筆者らが渉猟し得た範囲では，血管内手術が奏功した本疾患例の報告はなく，今回のものが最初と考えられる．

Bow hunter's stroke results from vertebrobasilar insufficiency due to a mechanical occlusion or stenosis of the vertebral artery caused by head rotation. We report here a case of bow hunter's stroke that was successfully treated with endovascular surgery. A 69-year-old male complained of intractable vertigo when he rotated his head to the right side. Neuroradiological studies proved that the symptom was attributed to the mechanical severe stenosis of the left vertebral artery at the C1-C2 level on head rotation,in addition to the atherosclerotic stenosis at the origin of the right vertebral artery. Two different treatments were considered,including direct surgeries to prevent the mechanical stenosis of the left vertebral artery,and an endovascular dilatation of the atherosclerotic stenosis of the right vertebral artery. Endovascular surgery with a stenting technique,which was thought to be less invasive,was undertaken and resulted in a complete relief of the patient's symptom. To our knowledge,this is the first report to have shown the efficacy of endovascular surgery on this uncommon disease.