造影剤アレルギーを有する脳血管障害患者に対する直達手術

抄録

In the field of vascular surgery, contrast-enhanced imaging using iodinated contrast media (ICM) is essential in determining the diagnosis and therapeutic strategy. However, in a few patients, contrast-enhanced imaging is contraindicated because of hypersensitivity against ICM or thyroid disease. We present two cases of direct surgery for cerebrovascular disease without using ICM in the preoperative evaluation. The first case was that of a 72-year-old woman who had a history of moderate allergy to ICM. She had transient weakness of the right upper extremity. Magnetic resonance (MR) images showed left intracranial internal carotid artery stenosis and multiple cerebral infarctions. Her symptom persisted despite antiplatelet therapy, and follow-up MR images revealed aggravation of the left-sided cerebral infarction. We performed left superficial temporal artery-middle cerebral artery anastomosis. After the operation, her symptoms disappeared. The second case was that of a 71-year-old woman with a history of severe ICM allergy. She presented with right-sided weakness, and MR images showed left internal carotid artery bifurcation stenosis. She underwent carotid endarterectomy for the prevention of recurrent cerebral infarction. We could perform treatment on schedule and found no perioperative complication in the 2 cases. By using multimodality evaluations, we could perform safe and secure surgery in the patients with hypersensitivity against ICM. Tailor-made decision on whether direct surgery should be performed with or without contrast medium examination is necessary for patients with hypersensitivity against ICM.