紡錘状椎骨-脳底動脈動脈瘤に対するステントとコイルの血管内治療

Combined Endovascular Stent Implantation and Coil Embolization for the Treatment of a Vertebro-Basilar Fusiform Aneurysm : Technical Case Report

I．はじめに

　明瞭なネックを持たない大型紡錘状脳動脈瘤の治療は非常に難しく，直達手術にせよ，血管内手術にせよ，母血管を閉塞せざるを得ないのが現状である．しかし椎骨脳底動脈には脳幹への穿通枝が存在するため，通常これを無視した長い距離の母血管閉塞はできない．くも膜下出血で発症した紡錘状椎骨脳底動脈瘤に対し，頭蓋内ステントを併用したコイル塞栓術を施行した．この治療の問題点，今後の課題などの考察を加え報告する．

We describe a case of the combined application of endovascular stent implantation and Guglielmi detach-able coil packing for the treatment of a vertebro-basilar fusiform aneurysm and review the literature on stent placement to treat cerebral aneurysms.

A 70-year-old female presented with an acute headache from subarachnoid hemorrhage. A fusiform aneurysm with a broad-based neck and dome, measuring 15mm, involving the union of the vertebral arter-ies and the proximal basilar artery was demonstrated on cerebral angiography. The aneurysm was judged to be inoperable and treated conservatively. Twelve days later the patient was transferred to our hospital for endovascular therapy. An intravascular stent (MultiLink) was placed across the base of the aneurysm through the right vertebral artery. After this, coil placement in the aneurysm around the stent was per-formed via a microcatheter guided from the left vertebral artery. After that a microcatheter was guided from the right vertebral artery through the interstices of the stent into the aneurysm, and additional coils were placed. Final angiography showed subtotal occlusion of the aneurysm and excellent blood flow of the parent artery through the stent. There were no new neurological deficits. Neither rerupture nor ischemic event has occurred.

The use of stents provides another treatment for managing the difficult entity of intracranial aneurysms.