脳動脈瘤塞栓術中にマイクロカテーテルの離断を来し，異物除去鉗子にて回収した1例

Retrieval of Migrated Microcatheter with Retrieval Forceps during Cerebral Aneurysm Embolization: A Case Report

Ⅰ．はじめに

　脳動脈瘤，脳動静脈奇形，硬膜動静脈瘻などに対する塞栓術は有効性が示され，ますます広がりつつある．塞栓術の合併症として，塞栓物質の迷入があり，異物を回収する手段も心得ておく必要がある^1,4,6)．今回，われわれは脳動脈瘤塞栓術中にマイクロカテーテルの離断を来し，異物除去鉗子にて回収した1例を経験した．症例を報告し，カテーテル離断，異物除去手技について考察する．

　Endovascular embolization for a cerebrovascular lesion has been increasingly performed. We experienced disruption of the microcatheter during a cerebral aneurysm embolization and removed the catheter fragment with retrieval forceps. A 56-year-old woman was brought to our hospital because of consciousness disturbance. Radiological examination revealed subarachnoid hemorrhage due to the rupture of an anterior communicating artery aneurysm. Despite endovascular embolization and neck clipping of the aneurysm, the aneurysm recurred. Then, endovascular embolization was performed. During introduction of the microcatheter to the cerebral aneurysm, the microcatheter disrupted spontaneously at the center of the catheter and the distal end of the catheter migrated into the right middle cerebral artery. The proximal part of the catheter fragment was located at the common carotid artery bifurcation. An attempt to retrieve the catheter by snare failed. Then, retrieval forceps were navigated. The catheter fragment was caught at the common carotid artery bifurcation and successfully removed. Subsequently, the cerebral aneurysm was embolized with detachable coils. No additional complication occured. Microscopical observation of the catheter end revealed relatively sharp disruption and extension of the stainless steel blade. Microcatheter disruption and migration is a rare but significant complication of endovascular embolization. Percutaneous technique with retrieval forceps for the extraction of intravascular foreign objects was useful.