緊急塞栓除去術が有効であった中大脳動脈塞栓症の１例

概要

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We report a case of successful emergency embolectomy in a patient with acute middle cerebral artery (MCA)embolism. A 67-year- old man with pulmonary fibrosis presented with sudden onset of right hemiparesis and aphasia.The brain CT scan was normal except or a high-density spot at the left MCA.A diffusionweighted magnetic resonance image showed a high-intensity area in the territory of the left ascending frontal artery.Cerebral angiography demonstrated nearly complete occlusion of the left MCA.A left frontotemporal craniotomy was performed. At surgery, the MCA was found to be occluded by an embolus, which was surgically removed. Postoperatively, the patient’s symptoms improved. CT scan showed only a small low density area, and an angiogram revealed complete recanalization of the MCA. The patient was discharged without neurological deficits. Recently,intra-arterial local fibrinolysis is commonly performed to restore cerebral blood flow in patients with acute MCA occlusion. Recanalization, however, is not obtainable in all patients, while embolectomy is a sure way to obtain it in spite of the longer time needed to prepare.In cases with preserved peripheral MCA circulation,embolectomy is in fact considered to be preferable to intra-arterial local fibrinolysis.
信州医学会の論文