IDC（Interlocking Detachable Coil）にて塞栓術を行った動脈瘤の1剖検例:走査電子顕微鏡による検討

Histological findings in aneurysm treated with IDC:scanning electron microscopical study

I．はじめに

　脳動脈瘤に対する血管内手術は近年IDC（Interlock—ing Detachable Coil：Target Therapeutics，USA），GDC（Guglielmi Detachable Coir：Target Therapeu—tics，USA）^5）等の塞栓材料やmicrocatheterの進歩によって発展してきており，良好な治療効果の報告も増加している^{1,13,15,16）}．しかしながらその基礎研究，特にcoilに対する組織反応やその経時的変化についての検討は動物を用いた実験例が散見されるものの^{2-4,7,9,10）}，ヒトにおける報告例はほとんど見られない．今回，IDCによる未破裂動脈瘤塞栓術後4週間での剖検例を経験し，走査電子顕微鏡による所見を得たので報告する．

We reported the scanning electron microscopic find-ings of an aneurysm embolized with interlocking de-tachable coils (IDC).

A 78-year-old man was referred to our hospital be-cause of left hemiparesis and dysphagia. CT scan showed multiple lacunar infarction in the bilateral coro-na radiata. Angiography demonstrated a small inciden-tal aneurysm of the right internal carotid artery (IC-PC junction). The left hemiparesis gradually improved and 2 weeks after admission the aneurysm was treated with IDC. Three coils were placed in the aneurysm and post-operative angiography demonstrated complete emboli-zation. Dysphagia caused by the pseudobulbar pulse did not improve and, 4 weeks after endovascular sur-gery, the patient died of aspiration pneumonia. An autopsy was performed and the scanning electron microscopical findings of the aneurysm showed de-velopment of endothelial cells on the coil surface. Many clinical reports supported the usefulness of Guglielmi detachable coils (GDC) and several ex-perimental reports demonstrated the intimal prolifera-tion in aneurysms embolized with coils. However, pathological changes of the aneurysms treated with coils have been reported in only four clinical cases. There was no evidence of endothelialization in any of these cases. To our knowlede, our case is the first re-port describing the endothelial proliferation over the coils.

It is necessary to accumulate histopathological data and long-term follow-up in humans treated with coils.