頚椎損傷に伴う椎骨動脈損傷の診断と治療 : 2症例の提示と血管内治療の適応に関する考察  [in Japanese] Vertebral Artery Injury associated with Cervical Spine Trauma : Indication for Endovascular Intervention  [in Japanese]

外傷性片側椎骨動脈損傷例で,末梢塞栓予防のために頚椎整復固定術前にコイル塞栓を施行した1例と,外傷性両側椎骨動脈損傷による小脳梗塞をきたし,減圧開頭の後,片側椎骨動脈をステント留置により血行再建した1例を提示する.頚椎損傷に伴う椎骨動脈損傷は臨床症状からの診断が困難であるが,重症外傷患者でスクリーニングとして行う体幹造影CTの撮像範囲を頭蓋底部まで拡大することにより,頚部血管損傷の急性期診断が可能となる.血管撮影や血管内治療の方法と時期は頚椎損傷の病状を考慮して決定する.椎骨動脈損傷は意外に頻度が高く,小脳,脳幹梗塞により重篤な神経症状を残すこともあるので,急性期の診断と治療は非常に重要である.

Two patients with vertebral artery injury associated with cervical spine trauma underwent successful endovascular intervention. One patient with unilateral vertebral artery dissection underwent coil embolization of the affected artery. The other with bilateral vertebral artery dissection suffered cerebellar infarction and underwent decompressive craniectomy. He had an endovascular stent implanted into one vertebral artery. Traumatic vertebral artery dissection and occlusion can cause serious neurologic deficits. Because clinical diagnosis of vertebral artery injury is often difficult in patients with severe trauma, radiological screening is important. We extended the field of view of routine screening contrast-enhanced chest and abdomen CT scan to include the cervical arteries for patients with severe trauma. This method contributes to the diagnosis of vertebral artery injury in the acute stage. Catheter angiography should be considered when vertebral artery injury is detected on CT scan. To prevent the devastating effect of cerebellar and brainstem infarction that may result from vertebral artery injury, endovascular revascularization or occlusion of the affected artery is a safe and useful option.