症 例
対側狭窄を伴う内頚動脈閉塞症に対して狭窄側への急性期ステント留置術が有効であった1例
キーワード:
carotid artery stenting,
progressive stroke,
internal carotid artery occlusion with contralateral stenosis
2019 年 47 巻 4 号 p. 285-289
詳細
2019 年 47 巻 4 号 p. 285-289
A 69-year-old man was found to have a new cerebral infarction in the right middle cerebral artery region. Magnetic resonance (MR) angiography revealed right internal carotid artery (ICA) occlusion and left ICA stenosis, and diffusion-weighted image/perfusion mismatch was observed. We initiated treatment with argatroban, aspirin, and clopidogrel, but the symptoms worsened [National Institutes of Health Stroke Scale (NIHSS) 6→10] on Day 5. MR imaging revealed infarct enlargement, and we performed an emergency carotid artery stenting for left ICA stenosis to improve blood flow through the anterior communicating artery. Postoperative single-photon emission computed tomography confirmed blood flow improvement on the occluded side, and the laterality resolved. His symptoms also improved to NIHSS 6, and he was transferred to a rehabilitation hospital with modified Rankin Scale 4. In our case, intervention increased antegrade blood flow, and a wide range of blood flow improvement including the occluded side can be expected.
