解離性椎骨動脈瘤に対するステントを用いた血管内治療 Stent Placement for the Treatment of Intracranial Vertebral Artery Dissecting Aneurysms

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Author(s)

    • 内藤 功 NAITO Isao
    • 老年病研究所附属病院 脳神経外科 Department of Neurosurgery, Geriatrics Research Institute and Hospital
    • 高玉 真 TAKATAMA Shin
    • 老年病研究所附属病院 脳神経外科 Department of Neurosurgery, Geriatrics Research Institute and Hospital
    • 岩井 丈幸 IWAI Tomoyuki
    • 老年病研究所附属病院 脳神経外科 Department of Neurosurgery, Geriatrics Research Institute and Hospital
    • 好本 裕平 YOSHIMOTO Yuhei
    • 群馬大学大学院 医学系研究科 脳神経外科 Department of Neurosurgery, Gunma University Graduate School of Medicine

Abstract

目的:解離性椎骨動脈瘤の治療は,血管内手技による母血管閉塞が第一選択の治療法であるが,虚血性合併症が問題となる.今回われわれは,血管内治療を施行した71例のうち,両側解離,対側の椎骨動脈低形成,後下小脳動脈(PICA)や前脊髄動脈(ASA)の血行温存などの理由からステントを併用した血管内治療を行った13例を検討した.方法:くも膜下出血発症が6例,虚血発症が4例,incidentalが1例であった.6例で解離部にPICAまたはASAがinvolveされていた.ステント併用瘤内塞栓術11例,ステント留置のみ2例であった.結果:ステント併用瘤内塞栓術を施行した11例のうち,1例で瘤内塞栓中に動脈瘤が破裂し,結果的に母血管閉塞となった.6例で動脈瘤の完全消失が得られ,4例でdome fillingであった.PICAまたはASAがinvolveされた6例では,ステントを併用し拡張部のみにコイルを留置することにより血行を温存できた.ステント留置のみの2例はfollow-upで拡張部の血栓化を確認した.虚血性合併症を1例に認めた.治療後,くも膜下出血をきたしたものはなかった.転帰はMRS 0-1が10例,3が1例,5が2例であった.結論:母血管閉塞により虚血性合併症の危険がある症例に対しては,ステントを併用した治療が有用と考えられる.PICAまたはASAがinvolveされた症例でもステントを併用し血行を温存できる場合がある.<br>

Intracranial vertebral artery (VA) dissecting aneurysms are commonly treated with endovascular parent artery occlusion. However, this procedure cannot be applied to patients with aplastic/hypoplastic contralateral VA or with posterior inferior cerebellar artery (PICA) involved in the dissecting segment. Recently, endovascular treatment using stents for VA dissecting aneurysms has been reported. In this study, we investigated the safety, efficacy, and optimal application of this treatment.<br> Thirteen patients were treated using stents to preserve the patency of the VA, PICA, and anterior spinal artery (ASA). In 6 patients, PICA or ASA was involved in the dissecting segment. Seven patients presented with subarachnoid hemorrhage (SAH), 4 with ischemic symptoms, 1 with headache without SAH, and 1 with incidental discovery. Eleven patients were treated with stent-assisted coil embolization and 2 with stenting only.<br> Stents were successfully deployed in all patients. Of the 11 patients treated with stent-assisted coiling, complete obliteration of the aneurysm was achieved in 5 patients and residual dome filling was present in 5. In the remaining patient, aneurysm rupture occurred during the insertion of the coils, and therefore parent artery occlusion was performed. In 2 patients treated with stenting only, complete obliteration was confirmed by follow-up angiography. Growth of the aneurysmal dilatation occurred in 1 patient, but subsequent SAH was not observed in any patient.<br> Endovascular treatment using stents and coils appears safe and effective, and provides an effective alternative to treating patients with aplasia/hypoplasia of the contralateral VA and some patients with involvement of the origin of PICA or ASA in the dissecting segment.<br>

Journal

  • Surgery for Cerebral Stroke

    Surgery for Cerebral Stroke 37(3), 184-191, 2009-05-31

    The Japanese Society on Surgery for Cerebral Stroke

References:  17

Cited by:  1

Codes

  • NII Article ID (NAID)
    10025951202
  • NII NACSIS-CAT ID (NCID)
    AN10061756
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    09145508
  • Data Source
    CJP  CJPref  J-STAGE 
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