Neurological Surgery 脳神経外科41巻4号

2013年04月発行

連載 脳神経血管内治療医に必要な知識

（8）頚動脈ステント留置術（CAS）以外の頭蓋内外血行再建術（脳血管攣縮を含む)

著者： 津本智幸¹

所属機関： ¹九州医療センター脳血管内治療科

ページ範囲：P.347 - P.358

Ⅰ．はじめに

　血管内治療における血行再建術としては，頚動脈ステント留置術（carotid artery stenting：CAS）が頻度の高い手技と考えるが，それ以外に，鎖骨下動脈病変，頭蓋外椎骨動脈病変，頭蓋内動脈病変，脳血管攣縮に対する血行再建術がある．今回は，これらの病変に対する診断，適応，術前・術後管理，手技について述べる．

参考文献

1) AbuRahma AF, Bates MC, Stone PA, Dyer B, Armistead L, Scott Dean L, Scott Lavigne P：Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease. J Endovasc Ther 14：698-704, 2007

2) Albuquerque FC, Fiorella D, Han P, Spetzler RF, McDougall CG：A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis. Neurosurgery 53：607-616, 2003

3) Babic S, Sagic D, Radak D, Antonic Z, Otasevic P, Kovacevic V, Tanaskovic S, Ruzicic D, Aleksic N, Vucurevic G：Initial and long-term results of endovascular therapy for chronic total occlusion of the subclavian artery. Cardiovasc Intervent Radiol 35：255-262, 2012

4) Canyigit M, Arat A, Cil BE, Turkbey B, Saatci I, Cekirge S, Balkanci F：Distal embolization after stenting of the vertebral artery：diffusion-weighted magnetic resonance imaging findings. Cardiovasc Intervent Radiol 30：189-195, 2007

5) Chastain HD 2nd, Campbell MS, Iyer S, Roubin GS, Vitek J, Mathur A, Al-Mubarak NA, Terry JB, Yates V, Kretzer K, Alred D, Gomez CR：Extracranial vertebral artery stent placement：In-hospital and follow-up results. J Neurosurg 91：547-552, 1999

6) Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsep HL, Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL Jr, Torbey MT, Zaidat OO, Rumboldt Z, Cloft HJ；SAMMPRIS Trial Investigators：Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365：993-1003, 2011

7) Coward LJ, Featherstone RL, Brown MM：Percutaneous transluminal angioplasty and stenting for vertebral artery stenosis. In：The Cochrane Library. John Wiley and Sons, Ltd, Chichester, UK, issue 2, 2005

8) Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM；CAVATAS Investigators：Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the carotid and vertebral artery transluminal angioplasty study（CAVATAS）a randomized trial. Stroke 38：1526-1530, 2007

9) Fiorella D, Derdeyn CP, Lynn MJ, Barnwell SL, Hoh BL, Levy EI, Harrigan MR, Klucznik RP, McDougall CG, Pride GL Jr, Zaidat OO, Lutsep HL, Waters MF, Hourihane JM, Alexandrov AV, Chiu D, Clark JM, Johnson MD, Torbey MT, Rumboldt Z, Cloft HJ, Turan TN, Lane BF, Janis LS, Chimowitz MI；SAMMPRIS Trial Investigators：Detailed analysis of periprocedural strokes in patients undergoing intracranial stenting in Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis（SAMMPRIS). Stroke 43：2682-2688, 2012

10) Hatano T, Tsukahara T, Miyakoshi A, Arai D, Yamaguchi S, Murakami M：Stent placement for atherosclerotic stenosis of the vertebral artery ostium：angiographic and clinical outcomes in 117 consecutive patients. Neurosurgery 68：108-116, 2011

11) Kusaka N, Tamiya T, Nishiguchi M, Takayama K, Nishiura T：Bilateral brachial pull-through technique for stenting in a patient with stenosis of the vertebral artery origin：technical case report. Neuroradiology 49：837-839, 2007

12) Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly JP, Morris RF, Ramee SR：Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 71：963-968, 2008

13) Rigatelli G, Cardaioli P, Giordan M, Panin S, Ferro S, Roncon L：New subclavian artery angioplasty technique for treating subclavian coronary steal syndrome. Ann Thorac Surg 84：688-689, 2007

14) SSYLVIA Study Investigators：Stenting of Symptomatic Atherosclerotic Lesions in the Vertebral or Intracranial Arteries（SSYLVIA）：study results. Stroke 35：1388-1392, 2004

15) 寺田友昭，津浦光晴，板倉　徹：椎骨，鎖骨下動脈狭窄症に対する血管内治療．脳外誌11：813-819, 2002

16) Tsumoto T, Terada T, Tsuura M, Matsumoto H, Masuo O, Yamaga H, Itakura T：Diffusion-weighted imaging abnormalities after percutaneous transluminal angioplasty and stenting for intracranial atherosclerotic disease. AJNR Am J Neuroradiol 26：385-389, 2005

17) Tsutsumi M, Kazekawa K, Onizuka M, Kodama T, Matsubara S, Aikawa H, Iko M, Nii K, Etou H, Tanaka A：Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis. Neuroradiology 49：253-257, 2007