頚部内頚動脈閉塞症を伴った側頭動脈炎に対する浅側頭動脈・中大脳動脈吻合術の1例

Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in a Patient of Temporal Arteritis with Internal Carotid Artery Occlusion: A Case Report

Ⅰ．はじめに

　側頭動脈炎は巨細胞性血管炎とも呼ばれ，頭頚部を中心とした中～大動脈に生じる巨細胞性の肉芽腫性血管炎で，浅側頭動脈，眼動脈，頭蓋外椎骨動脈が高率に傷害される．

　今回われわれは，側頭動脈炎に左内頚動脈閉塞を合併した症例に対して，左浅側頭動脈・中大脳動脈吻合術を行い，良好な結果を得た．症例を呈示し，治療方法や治療上の問題点について文献的考察を加えて報告する．

　Temporal arteritis is a rare systemic autoimmune disease and the arteritic process in this case of temporal arteritis involved large and medium-size arteries. Temporal arteritis with internal carotid artery (ICA) occlusion is very rare. We report a case of temporal arteritis with ICA occlusion following superficial temporal artery (STA) -middle cerebral artery (MCA) anastomosis,together with steroid therapy.

　A 73-year-old female presented with a headache, visual disturbance of left side, and suppression of activity. Left STA was inflammatory and overswelling. Magnetic resonance angiography (MRA) and angiography revealed occlusion of the left internal carotid artery (ICA) at the cervical portion and lowering of vascular reserve on PAO SPECT. Diagnosis as temporal arteritis was conclusive due to the clinical presentation, laboratory studies, and left temporal artery biopsy, so steroid pulse therapy was initiated. Inflammation of left STA disappeared after steroid therapy, but left ICA occlusion on angiography and lowering of vascular reserve on SPECT remained for 3 months afterwards. Because of this, STA-MCA anastomosis was performed. There were no complications after the operation and the donor artery has been patent for two years.

　Temporal arteritis with ICA occlusion that requires extracranial-intracranial bypass (EC-IC bypass) is very rare. STA-MCA anastomosis with steroid therapy is effective for the prevention of cerebral infarction.