屈曲病変へのcarotid artery stenting後に高度狭窄を来しステント除去を必要とした1例

Carotid Artery Stenting in a Tortuous Artery Results:A Case Report

Ⅰ．はじめに

　屈曲病変に対するステント留置術後，血管走行が変化し，屈曲部が移動することはしばしば経験される．今回，屈曲病変への頚動脈ステント留置術（carotid artery stenting：CAS）後に血管走行が変化してステント端が血管壁に当たり，ストラットの間から遠位へ血流が流れる状態になった結果，留置2年後に高度狭窄を来し，再治療を要した症例を経験した．

　Background:After carotid artery stenting（CAS）in a tortuous artery, the geometrics and elongation of the carotid artery sometimes change. It is not clear whether these changes induce post stent re-stenosis. We report a case of re-stenosis that occurred two years after CAS in a tortuous artery that required carotid endarterectomy with removal of the stent.

　Case Presentation:CAS was performed on a 78-year-old male who presented with symptoms of severe stenosis of a tortuous internal carotid artery. Eighteen months after stenting, the echogram revealed moderate stenosis at the distal end of the stent. Six months later, this developed into severe stenosis. Carotid angiography showed that the end of the stent was touching the wall of the internal carotid artery, and blood was passing through the stent wall. A re-CAS was difficult to perform;hence carotid endarterectomy with removal of the stent was performed successfully. He was discharged without any new neurological deficits.

　Conclusion:CAS on a tortuous carotid artery sometimes results in changes to the geometry and elongation of the artery. Potentially, this can lead to changes in the positional relationship between the stent and the artery, alteration of the wall shear stress and re-stenosis. Careful follow-up is needed after CAS on a tortuous artery.