Neurological Surgery 脳神経外科49巻3号

2021年05月発行

症例

血管内治療で救命し得たビニル傘による両側頚動脈穿通損傷の1例

著者： 望月達城¹ 劉美憬¹² 佐藤慎祐¹² 島彰吾¹ 井上龍也¹² 桒本健太郎¹ 新見康成² 岡田芳和¹

所属機関： ¹聖路加国際病院脳神経外科 ²聖路加国際病院神経血管内治療科

ページ範囲：P.677 - P.682

Ⅰ．はじめに
　外傷性頚動脈損傷（traumatic carotid injury：TCI）は本邦では極めて稀な外傷である．TCIは外傷機転により穿通性頚動脈損傷（penetrating TCI：PTCI）と非穿通性頚動脈損傷（Non-PTCI）に分類され，Non-PTCIでは仮性動脈瘤や動静脈瘻，動脈解離等の多様な臨床像が知られている^7）．PTCIでは頚動脈断裂に伴う出血が一般的な病態であるが，仮性動脈瘤や動静脈瘻を呈する症例も報告されている^{34, 37）}．頚動脈断裂は，大量出血，血腫による気道圧排，脳虚血など極めて重篤な病状を引き起こす．特に複数損傷部位による大量出血例の救命，治療は最も困難である^37）．これらの結果，PTCIの致死率は10〜22%と高く^{3, 8, 18, 23, 25, 34）}，救命例でも10〜19%で何らかの神経脱落症状を来す予後不良の疾患である^{8, 23, 34）}．特に両側PTCIによる活動性出血例で救命された症例報告は筆者らが文献的に渉猟し得た範囲（PubMed，医中誌）では1例であった^33）．
　今回，搬入時頚部より活動性出血を来していたビニル傘による両側PTCI症例を血管内治療により救命し得たので文献的考察を加えて報告する．

参考文献

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