症 例
クリッピング術とコイル塞栓術を併用して治療した破裂左C2部内頚動脈瘤の1例
2019 年 47 巻 2 号 p. 131-133
詳細
2019 年 47 巻 2 号 p. 131-133
Introduction: There are several factors to be considered in the treatment strategy for a ruptured internal carotid artery C2 segment aneurysm (IC-C2 AN), such as the morphology, size, and projecting direction of the AN. We report a case of successful treatment of a ruptured IC-C2 AN using neckplasty and clipping followed by coiling. We also discuss the possible treatment strategies for complicated cases of IC-C2 AN rupture in facilities without a hybrid operating room (OR).
Case presentation: A 62-year-old woman was admitted to our hospital with complaints of headache and vomiting. Her Glasgow Coma Scale score was 14 points (E3V5M6), and she had no other neurological deficits. Computed tomography (CT) revealed subarachnoid hemorrhage (SAH), and three-dimensional CT angiography (CTA) revealed a ruptured left IC-C2 AN. The neck width and length of the AN were 5.1 and 7.5 mm, respectively. We initially attempted treatment by clipping. However, complete clipping seemed extremely difficult. Therefore, we subsequently decided to perform neckplasty, followed by coiling. The postoperative CT scan revealed no newly developed high-density area (HDA) or low-density area (LDA). The patient underwent a ventriculoperitoneal (VP) shunt placement for hydrocephalus and was discharged 60 days after admission without neurological deficits.
Discussion: With regard to the optimal treatment of IC-C2 AN, the choice between coiling and clipping often remains controversial, and the combined strategy of coiling and clipping for IC AN has rarely been reported. In the present case, the AN had a broad neck, thereby making treatment with simple or balloon-assisted coiling difficult. As stent-assisted coiling for acute ruptured AN is currently off-label, we first used clipping owing to its technical reliability. During the operation, however, we judged that safe completion of the clipping was difficult and opted for neckplasty with a clip, followed by coiling, as our treatment strategy. In facilities where hybrid OR is unavailable, like ours, blind clipping is risky; hence, some other optimal treatment strategy should always be sought.
Conclusion: We report a case of IC-C2 AN rupture treated successfully with neckplasty with clipping and subsequent coiling.
