ダビガトランとアスピリン内服で内頸動脈可動性血栓が消失した非弁膜症性心房細動合併アテローム血栓性脳梗塞の1 例  [in Japanese] Successful resolution of mobile thrombus in internal carotid artery with dabigatran and aspirin in an atherothrombotic cerebral infarction patient with non-valvular atrial fibrillation  [in Japanese]

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Author(s)

    • 上床 希久 Uwatoko Kiku
    • 佐賀大学医学部内科学神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 井手 俊宏 Ide Toshihiro
    • 佐賀大学医学部内科学神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 田畑 絵美 Tabata Emi
    • 佐賀大学医学部内科学神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 吉川 正章 Yoshikawa Masaaki
    • 佐賀大学医学部内科学神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine
    • 原 英夫 Hara Hideo
    • 佐賀大学医学部内科学神経内科 Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine

Abstract

症例は83 歳,男性.一過性脳虚血発作を契機に両側内頸動脈狭窄症を指摘されており,非弁膜症性心房細動に対しワルファリン内服中であった.構音障害,左顔面麻痺,左上肢の脱力を主訴に来院し,拡散強調画像で右中大脳動脈に散在性の多発脳梗塞を認めた.入院後の頸動脈超音波検査で右内頸動脈に付着する可動性構造物が確認された.脳梗塞再発予防としてダビガトランとアスピリン内服による外来通院加療を継続し,可動性構造物は経時的に縮小・消失したため,同構造物は血栓であったと判断した.頸動脈可動性血栓を有する脳梗塞症例は再発率が高いが,有効な再発予防法や血栓除去手段についてはよくわかっていない.頸動脈可動性血栓の縮小・消失に対するダビガトランを含む非ビタミンK 阻害経口抗凝固薬の投与は,類似の症例における治療選択肢の一つとなり得る.

A 83-year-old man with a history of transient ischemic attack (TIA) was referred to our hospital with dysarthria, left-sided facial palsy, and weakness of the left arm. For the secondary prevention of ischemic stroke, warfarin was administered because he had non-valvular arterial fibrillation. Magnetic resonance imaging of the brain revealed multiple infarctions at the right middle cerebral artery. Carotid ultrasonography revealed severe stenosis at the right internal carotid artery with a mobile structure. After administration of combined antithrombotic therapy with dabigatran and aspirin, repeated carotid ultrasonography revealed serial reduction of the mobile structure, and disappeared on day 66. On day 101, the right internal carotid artery successfully underwent carotid artery stenting. After 1 year, neither recurrence of ischemic stroke nor new mobile structures had been noted. These findings allowed us to diagnose the mobile structure as thrombus. This case suggests that combination therapy with non-vitamin K oral anti-coagulant and aspirin is an appropriate therapeutic option for mobile plaques on carotid artery stenosis in patients with non-valvular arterial fibrillation.

Journal

  • Nosotchu

    Nosotchu 39(4), 277-281, 2017

    The Japan Stroke Society

Codes

  • NII Article ID (NAID)
    130005858953
  • Text Lang
    JPN
  • ISSN
    0912-0726
  • Data Source
    J-STAGE 
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