頸動脈ステント留置後に上行大動脈置換術を実施して救命した左総頸動脈急性閉塞合併Stanford A型急性大動脈解離の1例

Successful Repair of Acute Aortic Dissection after Stent Placement into the Occluded Left Common Carotid Artery；Report of a Case

はじめに　脳循環不全による意識障害を伴う急性大動脈解離は，死亡率や神経学的合併症発生率の高さから手術適応に関して議論の余地があるが1），可能であれば早期の脳循環不全の改善が重要ともされている．当施設において総頸動脈急性閉塞を合併した急性大動脈解離において，頸動脈ステント留置後翌日に上行大動脈置換術を実施し，救命した1例を経験したので報告する．

A 63-year old woman was admitted to our hospital due to loss of consciousness［Glasgow Coma Scale （GCS） E1V1M4］. Cerebral angiography showed known severe stenosis in the right common carotid artery and acute occlusion of the left common carotid artery. Enhanced computed tomography（CT） revealed Stanford type A acute aortic dissection. We judged an emergency surgery was not indicated for this comatose patient. Neurosurgeons placed stents into the left common and internal carotid arteries. The next day, the patient regained consciousness （GCS E4V2M6）， and we performed ascending aorta replacement. There was an intimal tear in the ascending aorta and proximal end of the left carotid artery stent was visible in the aortic arch. Postoperative course was uneventful, and CT revealed successful aortic repair and patent stents in the left carotid artery. She was transferred to a rehabilitation hospital on postoperative day 44. Although stent insertion into carotid arteries in a patient with acute aortic dissection carries some risks such as making a new intimal tear or catheterizing in a false lumen, early cerebral reperfusion may improve prognosis of the patients with acute aortic dissection with cerebral malperfusion.