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頚動脈内膜剝離術の全身麻酔導入を契機に冠攣縮による心停止を来した1例
著者： 佐藤公俊1 阿部克智1 小坂康晴2 大内武3 岡本浩嗣2 阿古潤哉3 隈部俊宏1
所属機関： 1北里大学医学部脳神経外科 2北里大学医学部麻酔科 3北里大学医学部循環器内科
ページ範囲：P.591 - P.598
文献購入ページに移動Ⅰ．はじめに
内頚動脈狭窄症（internal carotid stenosis：ICS）の外科的血行再建術〔頚動脈内膜剝離術（carotid endarterectomy：CEA）もしくは頚動脈ステント留置術（carotid artery stenting：CAS）〕では，高い安全性が求められる3,17)．ICSに対するrandomized clinical trialsでは，心筋梗塞（myocardial infarction：MI）や死亡がendpointとして含まれていることも多く2,5,6,9,14,22,24)，ICS患者の治療では心臓合併症にも留意する必要がある13)．
MIを含む急性冠症候群の28%は冠動脈に責任病変が認められず，そのうちの49%は冠攣縮が原因とされる19)．冠攣縮はMIや重症不整脈の原因となり，非心臓手術の周術期にも起こり得る11,12,16,26)．しかし，術前に予測できるまでには至っていない．
今回，CEA術前の精査で異常を指摘できず，全身麻酔導入を契機に完全房室ブロックから心停止となり，後日冠攣縮と診断した1例を経験した．
内頚動脈狭窄症（internal carotid stenosis：ICS）の外科的血行再建術〔頚動脈内膜剝離術（carotid endarterectomy：CEA）もしくは頚動脈ステント留置術（carotid artery stenting：CAS）〕では，高い安全性が求められる3,17)．ICSに対するrandomized clinical trialsでは，心筋梗塞（myocardial infarction：MI）や死亡がendpointとして含まれていることも多く2,5,6,9,14,22,24)，ICS患者の治療では心臓合併症にも留意する必要がある13)．
MIを含む急性冠症候群の28%は冠動脈に責任病変が認められず，そのうちの49%は冠攣縮が原因とされる19)．冠攣縮はMIや重症不整脈の原因となり，非心臓手術の周術期にも起こり得る11,12,16,26)．しかし，術前に予測できるまでには至っていない．
今回，CEA術前の精査で異常を指摘できず，全身麻酔導入を契機に完全房室ブロックから心停止となり，後日冠攣縮と診断した1例を経験した．
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