頚部頚動脈瘤に対し血管内治療を行った1例

Endovascular Treatment for Cervical Carotid Artery Aneurysm: A Case Report

Ⅰ．はじめに

　頚部頚動脈瘤は比較的稀な疾患であり，その発生頻度は全頭蓋外動脈瘤のうち0.4～1％と報告されている^5,6,9,17,19)．これまで，さまざまな外科的治療が行われてきたが，治療器具や技術の進歩，さらにその低侵襲性から，近年は血管内治療を行ったという報告が散見される^{3,4,7,11-14,17,22-24,26)}．今回，われわれは頚部頚動脈瘤に対して血管内治療を行い良好な結果を得られた症例を経験したので，文献的考察を加えて報告する．

　We report here a case of cervical carotid artery aneurysm. This 37-year-old male suffered from acute neck swelling when he was taking lunch after physical work. Ultrasonography demonstrated a cervical pseudoaneurysm and a jet flow, which was blowing into the dome from the carotid artery. Angiogram revealed an aneurysm with a diameter of 3cm at the bifurcation of the common carotid artery. Coil embolization using double-catheter technique was performed and complete occlusion of the aneurysm was obtained without any complications. The patient returned to his normal life.

　Cervical carotid artery aneurysms are rare and they induce pain by swelling in the neck, hoarseness, swallowing disturbance, hemorrhage, and cerebral ischemia due to embolism. In case of a cervical carotid artery aneurysm, safe and effective treatments are required and endovascular treatment should be considered. Although stent-assisted coil embolization or covered-stent placement were reported as an effective treatment for cervical aneurysms, coil embolization without using a stent was performed in this particular patient who is a young, blue-collar worker because the avoidance of long-term anti-platelet therapy was desirable. Preoperative evaluation is important to select adequate treatment.