Neurological Surgery 脳神経外科40巻3号

2012年03月発行

症例

塞栓術中にコイルが逸脱してきた内頚動脈瘤の1例

著者： 林健太郎¹ 堀江信貴¹ 森川実² 竹下朝規¹ 陶山一彦¹ 永田泉¹

所属機関： ¹長崎大学医学部脳神経外科 ²長崎大学医学部放射線科

ページ範囲：P.271 - P.276

Ⅰ．はじめに

　近年，脳動脈瘤に対するコイル塞栓術はますます普及しつつある．Wide-neckの動脈瘤では，塞栓術中や術後にコイルが母血管に逸脱してくることがある．今回，われわれは内頚動脈瘤の塞栓術中に，離脱したコイルが逸脱してきた症例を経験した．文献的考察を加えて報告する．

参考文献

1）Bradac GB, Bergui M, Stura G, Fontanella M, Daniele D, Gozzoli L, Berardino M, Ducati A：Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC：a retrospective 12-year experience of a single center. Neurosurg Rev 30：117-126, 2007

2）Chen Z, Tang W, Feng H, Zhu G：Surgical extraction of migrated coils via proximal segment of the anterior cerebral artery：an emergency alternative. Neurol India 57：327-330, 2009

3）Cho CS：Coil Migration under Stent-Assisted Embolization. A Case Report. Interv Neuroradiol 12：65-68, 2006

4）Deshmukh VR, Klopfenstein J, Albuquerque FC, Kim LJ, Spetzler RF：Surgical management of distal coil migration and arterial perforation after attempted coil embolization of a ruptured ophthalmic artery aneurysm：technical case report. Neurosurgery 58 (4 suppl 2)：ONS-E379, 2006

5）Dinc H, Kuzeyli K, Kosucu P, Sari A, Cekirge S：Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms. Neuroradiology 48：269-272, 2006

6）Fiorella D, Kelly ME, Moskowitz S, Masaryk TJ：Delayed symptomatic coil migration after initially successful balloon-assisted aneurysm coiling：technical case report. Neurosurgery 64：E391-392, 2009

7）Lee CY：Use of wire as a snare for endovascular retrieval of displaced or stretched coils：rescue from a technical complication. Neuroradiology 53：31-35, 2011

8）Luo CB, Chang FC, Teng MM, Guo WY, Chang CY：Stent management of coil herniation in embolization of internal carotid aneurysms. AJNR Am J Neuroradiol 29：1951-1955, 2008

9）目黒俊成，佐々木達也，春間　純，田邊智之，村岡賢一郎，寺田欣矢，廣常信之，西野繁樹：脳動脈瘤塞栓術中に逸脱したコイルが，後に血管狭窄を引き起こした1例．No Shinkei Geka 38：41-45, 2010

10）諸藤陽一，宗　剛平，日宇　健，川久保潤一，林　健太郎，北川直毅，森川　実，陶山一彦，永田　泉：頚動脈血行再建術における術前血小板凝集能測定の有用性．No Shinkei Geka 39：459-463, 2011

11）Motegi H, Isobe M, Isu T, Kamiyama H：A surgical case of delayed coil migration after balloon-assisted embolization of an intracranial broad-neck aneurysm：case report. Neurosurgery 67 (2 suppl operative)：516-521, 2010

12）Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, Kassam A：Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26：506-514, 2005

13）Sourour N, Góngora-Rivera F, Biondi A：Additional Rescue Stent Placement for Stabilization of a Prolapsed Coil during Stent-assisted Coil Embolization of a Wide-Neck Intracranial Aneurysm. Interv Neuroradiol 12：257-262, 2006

14）Vora N, Thomas A, Germanwala A, Jovin T, Horowitz M：Retrieval of a displaced detachable coil and intracranial stent with an L5 Merci Retriever during endovascular embolization of an intracranial aneurysm. J Neuroimaging 18：81-84, 2008

15）Yamada NK, Cross DT 3rd, Pilgram TK, Moran CJ, Derdeyn CP, Dacey RG Jr：Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms. AJNR Am J Neuroradiol 28：1778-1782, 2007