ステント留置術後にmicroembolic signalの消失を確認した頚部内頚動脈狭窄症の1例  [in Japanese] Disappearance of microembolic signals on transcranial doppler after carotid artery stenting: A case report  [in Japanese]

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Abstract

<b>【目的】</b>内科治療抵抗性のmicroembolic signal(MES)陽性頚部内頚動脈(internal carotid artery;ICA)狭窄症に対して頚動脈ステント留置術(carotid artery stenting;CAS)を施行し,MES消失と脳梗塞再発防止に貢献した症例を報告する.<b>【症例】</b>65歳男性.一過性右不全片麻痺を主訴に受診した.左中大脳動脈領域の多発梗塞と左頚部ICAの中等度狭窄を認めた.抗血小板療法開始後も梗塞巣が増加し,経頭蓋ドップラー(transcranial Doppler;TCD)で患側中大脳動脈において30分間に5個のMESが検出された.内科治療抵抗性に塞栓症を繰り返す左頚部ICA狭窄と判断し,Carotid Wallstentを用いてCASを施行した.術5日後のTCDではMESは検出されなかった.<b>【結論】</b>CASにより動脈原性塞栓症を阻止することができた.治療効果判定にTCDが有用であった.

<b>Objective</b>: Microembolic signals (MES) are a predictor of future stroke in patients with carotid artery stenosis. We report a case of carotid artery stenosis in which transcranial Doppler (TCD) showed disappearance of MES after carotid artery stenting (CAS).<br><b>Case presentation</b>: A 65-year-old man presented with transient left hemiparesis and homonymous left hemianopsia. Diffusion-weighted magnetic resonance (MR) imaging showed new infarction in the territory of the left middle cerebral artery, and MR angiography showed moderate stenosis in the left cervical internal carotid artery. Although dual antiplatelet treatment was administered, diffusion-weighted MR imaging showed increased infarction, and TCD detected 5 MES in 30 minutes. We decided to perform CAS to prevent artery-to-artery embolism, which was recurrent despite optimal medical treatment. CAS was performed with a Carotid Wallstent 19 days after the onset. TCD obtained 5 days after CAS detected no MES, and no new infarcts were detected as of 1 year after CAS.<br><b>Conclusion</b>: CAS using the Carotid Wallstent can prevent medication-resistant embolic stroke due to carotid artery stenosis, and TCD is useful to evaluate the effect of the treatment.

Journal

  • Journal of Neuroendovascular Therapy

    Journal of Neuroendovascular Therapy 6(2), 114-121, 2012

    The Japanese Society for Neuroendovascular Therapy

Codes

  • NII Article ID (NAID)
    130002148781
  • NII NACSIS-CAT ID (NCID)
    AA1229439X
  • Text Lang
    JPN
  • ISSN
    1882-4072
  • NDL Article ID
    024015570
  • NDL Call No.
    Z74-F710
  • Data Source
    NDL  J-STAGE 
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