Pushable coilで母血管閉塞術を施行したcarotid blowout syndromeの1例

Carotid Blowout Syndrome Treated by Parent Artery Occlusion Using Pushable Coils: A Case Report

Ⅰ．はじめに

　Carotid blowout syndrome（CBS）は，頚部の頚動脈破裂，もしくは頚動脈の露出を意味し，頭頚部癌の致死的合併症の1つである^1-4,7-12)．頻度としては3～5%程度と報告されている^3,7,10,11)．治療は血管内治療による頚動脈閉塞やcovered stentが第一選択となる^{1,2,4,5,9,10)}．頚動脈閉塞には多数のcoilを使用するため，医療経済的には大きな負担になる．今回われわれは，食道癌術後に頚部リンパ節郭清，放射線照射を施行後に皮膚潰瘍を呈し，それに伴うCBSに対しpushable coilで母血管閉塞を施行した1例を経験したので，文献的考察を加えて報告する．

　Objective：Here we report a case of carotid blowout syndrome (CBS) treated with parent artery occlusion using pushable coils.

　Case presentation：A 68-year-old man with a history of surgery and chemoradiation therapy for esophageal cancer 9 years prior presented with a massive hemorrhage from a skin defect in the neck. Angiography revealed encasement of the right common carotid artery by radiation necrosis, and CBS was diagnosed. We performed emergent endovascular treatment, and the right common carotid artery was occluded using pushable coils and a detachable coil. The patient's postoperative course was uneventful. However, he died of esophageal cancer recurrence 6 months later.

　Conclusion：Pushable coils were useful for occluding the parent artery in this case of CBS.