巨大脳動脈瘤に対して直視下に頚動脈へ2本のシースを留置して治療を行った1例

A Case of Giant Cerebral Aneurysm Treated with Multiple Sheaths Directly Punctured into the Carotid Artery

Ⅰ．はじめに

　脳血管内手術において，さまざまな要因により上腕や鼠径部からのアプローチが困難な場合，その代替として頚動脈の直接穿刺が行われる^4,5)．今回，頭蓋内内頚動脈巨大動脈瘤に対して，頚部切開して直視下に総頚動脈（common carotid artery：CCA）に2本のシースを挿入・留置して，フローダイバーターステント（flow diverter stent：FDS）留置および瘤内コイル塞栓を行ったので，その手技に関して報告する．

　When it is difficult to approach the brachial or femoral artery during endovascular surgery, an alternative approach is the direct puncture of the carotid artery. In this case of a giant cerebral aneurysm, we punctured the carotid artery directly and performed flow diverter stent placement and endosaccular coil embolization. Although the procedure required two thick access routes, it was performed after administering two antiplatelet drugs and an anticoagulant in order to achieve reliable hemostasis of the puncture sites after the operation. Direct common carotid artery puncture through a cervical skin incision is useful, because it ensures multiple access routes safely and provides secure hemostasis of the puncture sites.