急性期に血栓摘出術を行なった頸部ならびに頭蓋内血栓症の1例

概要

論文の詳細を見る
A 32-year-old man suffered from weakness and hypaesthesia of the right upper limb about eight months prior to admission. A left carotid arteriogram demonstrated marked stenosis of the left internal carotid artery at the level of the bifurcation. At seven hours after the study, right hemiplegia, aphasia and decreasing consciousness level appeared. About two hours after the onset of the symptoms, a thromboendarterectomy of the left internal carotid artery, followed by extraction of the remaining fresh clot distal to it, using No-4 Fogary catheter, was performed. Although there was good retograde bleeding, intraoperative CAG showed partial occlusion of the C-2 portion and total obstruction of the left middle cerebral artery distal to its perforators. Immediately, a left fronto-temopral craniotomy was made. Through arteriotomies made in the C2, M1 and M2 portions, thrombi were removed. Interrupted sutures with 10-0 stainless-steel-wire were used for closure of the incisions. One week after the surgery, the patient became alert. 2 months later he had gained good moter power (4/5) in his right limbs and was able to walk alone. A repeated CAG showed that the left carotid and middle cerebral arteries were patent. Previous reports on this subject were reviewed.