脳梗塞急性期にEC-ICバイパス術を行った妊婦の1例

A Pregnant Case on which EC-IC Bypass was Successfully Performed in the Acute Phase of Brain Infarction

Ⅰ．はじめに

　妊娠中は凝固機能が亢進する一方で線溶系は抑制され，血栓を生じやすい状態であることが知られている^2,13)が，妊娠中に脳卒中を生じるリスクは出産直前までは非妊娠女性と変わらないとされている³⁾．われわれは妊娠28週の妊婦に生じた進行性脳梗塞に対し，急性期浅側頭動脈─中大脳動脈（STA-MCA）バイパス術を行い，母子ともに良好な結果を得た．治療抵抗性の進行性脳梗塞に対する急性期バイパス術は近年行われつつある^{5-7,9,12,15,16,19,20)}が，妊婦に適応させた報告はなく，貴重な治療経験と思われるため報告する．

　A 30 year-old,28 weeks-pregnant woman (gravida 2,para 2) suffered from a sudden onset of aphasia when she was having a chat in the upright position. Although the initial symptom soon disappeared,transient attacks of aphasia combined with weakness in the right arm occurred intermittently,particularly when she uprose. MR image disclosed a small acute infarcted focus at the genu of the left internal capsule,while MRA showed an occlusion of the intracranial portion of the left internal carotid artery. She was treated conservatively,but the transient attack continued and her consciousness was slightly lowered. Since repeated examination revealed no recanalization of the occluded artery,treatment was reinforced by using heparin and dopamine on day 1. However,her consciousness was not improved,and dopamine evoked nausea and vomiting. On day 2,superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis was carried out. Soon after surgery,she regained alertness and the transient attack subsided. Examinations could not clarify the course of the occlusion. She was treated with heparin until she delivered a sound baby in the 37th week. Although STA-MCA anastomosis for acute ischemic stroke is still debatable,it may be a good option even for a pregnant woman when suffering from intractable progressing stroke.